Overview

Anemia is characterized by an insufficient number of red blood cells (RBCs). RBCs

carry oxygen from the lungs to tissues throughout the body. All cells require oxygen
to function.
Red blood cells originate in bone marrow as erythroblasts (a "blast" is a primitive cell
that develops into a mature cell). Hemoglobin (Hb), a protein that binds to oxygen,
is the main component of red blood cells. Once RBCs become filled with hemoglobin
they enter the bloodstream as erythrocytes. Healthy hemoglobin holds the oxygen
molecules with a precise degree of force. If it binds oxygen molecules in the lungs
too loosely, it cannot hold onto them and carry them away. If it binds them too
tightly, it cannot release them to tissues.
Red blood cell production is stimulated by the hormone erythropoietin (EPO), which
is produced in the kidneys. If the kidneys fail to produce adequate EPO, anemia
develops.
Blood Transfusion
Hospitals use blood supplied by blood banks (companies that collect, prepare, and
store blood for medical and emergency uses). Blood banks type blood and test the
compatibility of donor and recipient blood before transfusion (called cross-matching).
Blood types are A, B, AB, and O. Whether the type is positive or negative depends on
whether the Rh factor is present on the person's red blood cells. All types can receive
O negative blood, but may not be compatible with other types:

Recipients
Recipients
Recipients
Recipients
Recipients
Recipients
Recipients
Recipients

with
with
with
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A+ blood type can receive A+, A-, O+ and O- blood types

B+ blood type can receive B+, B-, O+ and O- blood types
AB+ blood type can receive AB+, AB-, O+ and O- blood types.
O+ blood type can receive O+ and O- blood types
A- blood type can receive A- and O- blood types
B- blood type can receive B- and O- blood types
AB- blood type can receive AB- and O- blood types.
O- blood type can receive O- blood type.

Blood products commonly transfused in intensive care units (ICUs) include

red blood cells (RBCs)contain hemoglobin, which carries oxygen to all

tissues;
plasmastraw-colored fluid that carries the blood cells, enzymes, and
hormones throughout the body; and
plateletscell-like bodies that control bleeding.

Blood banks also test blood for anemia and pathogens (disease-causing bacteria and
viruses), including hepatitis viruses B and C, human immunodeficiency virus (HIV),
and Treponema pallidum (bacterium that causes syphilis).
Despite the many regulations in place to assure the safety of blood supplies,
transfusions are not risk free. Possible complications of blood transfusions include

allergic reaction (caused by an allergen in the donor blood) and

hemolytic transfusion reaction (caused by incompatible blood).

Managing patients in ICU requires strategies to minimize blood loss and increase
production of blood in bone marrow. Limiting laboratory testing and phlebotomy
(drawing blood) are important components of blood management.
Other Treatment
Injectable EPO (e.g., PROCRIT, EPOGEN) is an alternative to blood transfusion to
treat critically ill patients with anemia. Exogenous EPO is identical to the natural
hormone in its role of stimulating the bone marrow to produce red blood cells. EPO
has been used safely in many clinical settings, including chronic renal failure,
oncology, and surgery. In the ICU, use of EPO has been shown to reduce the amount
of blood transfused by almost 50%, at the same time significantly increasing
hemoglobin levels.