ICU内的贫血（英文）.pptVIP

Anemia in the ICU:An Evidence Based Approach Andrew F. Shorr, MD, MPH Walter Reed Army Medical Center Overview What is current transfusion practice? What are the risks of transfusion? Is there an optimal hemoglobin? Are there alternatives to the use of pRBCs? Transfusion in the U.S. 12 million units given each year Common indications Bleeding Ischemia Resuscitation ? Any indication Costs of Transfusion Some estimates range from $100-$150/ unit Earlier studies fail to account for Costs of nursing time Costs of additional testing Costs of reactions More recent estimates: $250-$300/ unit pRBC Cost of Transfusion Cost of pRBCs changing Leukoreduction Nucleic Acid Testing (NAT) Estimated increase in cost over next several years: $50-$100/unit New total cost to healthcare system -- at least $60 million Transfusion in the ICU Retrospective review of patients in ICU 1 week 85% received pRBCs Average transfusion: 9.5 units Indications for transfusion No clear indication: 29% Low Hct: 19% Average daily blood loss from phlebotomy: 70 ml/day Transfusion in the ICU Practice survey in Canada 76% of all Canadian CCM MD participated Queried regarding Current transfusion practice in ICU Presented with hypothetical cases Transfusion in the ICU Transfusion in the ICU On average, pRBCs used in the ICU Are at least 2 weeks old Lack sufficient 2,3 DPG Have diminished O2 carrying capacity Remain in the circulation for only a short time Risks of Transfusion Infection Transfusion reaction Immunomodulatory Volume-related Blood Borne Infections Blood and the Immune System Despite filters, WBCs remain in pRBCs Transfusion promotes cytokine release Alters cellular immunity: Decreased: CD4 cells, NK cells, IL-2 production Increases: B cells, CD8 suppressor cells, PGE2 Blood and the Immune System Design: Prospective, observational study Subjects: CABG patients Comparisons: transfused vs. no transfusion intraoperatively Measurements: IL-6, BPI n=136 Blood and the Immune System Do the