Erythropoietin in the critically ill

The issues surrounding red blood cell (RBC) transfusion are important in the critically ill. Anaemia is very common in the critically ill; almost 95% of patients admitted to the intensive care unit (ICU) have a haemoglobin level below normal by ICU day 3 [1]. As a result, critically ill patients receive a significant number of RBC transfusions during their ICU stay. Studies almost a decade ago found that over 50% of all patients admitted to the ICU were transfused during their ICU stay [2]. Among patients with a prolonged ICU stay (greater than 1 week), 85% received a transfusion [3]. On average, these latter patients were each transfused with over 9 units of RBCs during their ICU admission. These transfusions were not restricted to the early ICU course, but rather were transfused at a rate of 2 to 3 units per week. In a descriptive study of critical care units in the United States [4], on a single day almost 14% of patients in critical care units are transfused (ranging from 4% in CCUs to 27% in SICUs).