The Postinjury Inflammatory State and the Bone Marrow Response to Anemia

Rationale: The pathophysiology of persistent injury-associated anemia is incompletely understood, and human data are sparse. Objective: To translate pre-clinical findings by characterizing injury-associated anemia among critically ill trauma patients. This study compared elective hip repair patients with an acute stress response to severely injured trauma patients with a prolonged stress response and evaluated the bone marrow response to anemia. Methods: A translational prospective observational cohort study comparing severely injured, blunt trauma patients who had operative fixation of a hip or femur fracture (n=17) with elective hip repair patients (n=22) and healthy donors (n=8). Measurements and Main Results: During admission, trauma patients had 625 mL operative blood loss, five units of red blood cell transfusions, and hemoglobin decreased from 10.5 to 9.3 g/dL. Compared with hip repair, trauma patients had higher plasma norepinephrine (21.9 vs. 8.9 ng/mL*) and hepcidin concentrations (56.3 vs. 12.2...