Red blood cell physiology in critical illness

2003/12/01 by Marion Scharte, Mitchell P. Fink · 1 citation
Medicine · #Erythrocyte Function and Pathophysiology #Blood properties and coagulation #Erythropoietin and Anemia Treatment

paper · doi:10.1097/01.ccm.0000098036.90796.ed

Abstract

OBJECTIVE: Reduction in red blood cell mass, as well as structural and functional alterations of erythrocytes, occurs in critical illness. This review discusses these changes in red blood cell physiology, emphasizing the pathogenesis of anemia in intensive care unit patients. DATA SOURCE: Studies published in biomedical journals. DATA SYNTHESIS AND CONCLUSION: Anemia in intensive care unit patients resembles the anemia of chronic disease, being characterized by diminished erythropoietin production relative to decreased hematocrit, altered iron metabolism, and impaired proliferation and differentiation of erythroid progenitors in the bone marrow. Inflammatory mediators play a major role in the development of insufficient erythropoiesis and altered iron metabolism. Furthermore, a proinflammatory milieu promotes structural and functional alterations of erythrocytes, impairing their deformability and possibly impairing microvascular perfusion. Collectively, these changes in red blood cell physiology can impair oxygen transport to tissues and, thereby, might contribute to the development of multiple organ failure in critical illness.

Citations

• Regulation of Cellular Iron Metabolism by Erythropoietin: Activation of Iron-Regulatory Protein and Upregulation of Transferrin Receptor Expression in Erythroid Cells

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• Red cell distribution width and all-cause mortality in critically ill patients*

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