Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

ABSTRACT

Anemia is very common in critical care patients, on admission (affecting about two thirds ofpatients), but also during and after their stay, due to repeated blood loss, the effects of inflammation onerythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated withseverity of illness and length of stay.Methods: A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT,evaluated three fields (1) anaemia prevention, (2) transfusion strategies and (3) non-transfusiontreatment of anaemia. Population, Intervention, Comparison, and Outcome (PICO) questions werereviewed and updated as needed, and evidence profiles were generated. Analysis of the literature andformulation of recommendations were then conducted according to the GRADE1methodology.Results: The SFAR-SRLF guideline panel provided ten statements concerning the management of anemiain adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope ofthese recommendations. After two rounds of discussion and various amendments, a strong consensuswas reached for ten recommendations. Three of these recommendations had a high level of evidence(GRADE 1) and four had a low level of evidence (GRADE 2). No GRADE recommendation could be providedfor two questions in the absence of strong consensus.Conclusions: The experts reached a substantial consensus for several strong recommendations foroptimal patient management. The experts recommended phlebotomy reduction strategies, restrictivered blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless ofstorage time, treatment of anemic patients with erythropoietin, especially after trauma, in the absence ofcontraindications and avoidance of iron therapy (except in the context of erythropoietin therapy). C2020 The Author(s). Published by Elsevier Masson SAS on behalf of Socie ́te ́franc ̧aise d'anesthe ́sie et dere ́animation (Sfar).