The Internet Book of Critical Care Podcast IBCC Episode 9 - Anemia
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Oct 31, 2018 This podcast discusses the causes, evaluation, and management of anemia in critically ill patients. It emphasizes the importance of understanding underlying causes and takes a simple approach to transfusion goals. Specific topics include evaluation methods, risks of traumatic injuries during CPR, blood transfusion considerations for different patient populations, and strategies to avoid hemoglobin drift.
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Focus on Loss, Not Production
- Acute hemoglobin drops in ICU patients usually stem from blood loss or hemolysis, not bone marrow production issues.
- This insight simplifies the anemia workup in critical care to focus on hemorrhage and hemolysis causes.
Prevent ICU Hemoglobin Drift
- Limit blood draws in ICU patients to avoid hemoglobin drift caused by iatrogenic blood loss.
- Use smaller pediatric tubes and minimize labs to conserve patient blood volume.
Restrictive Transfusion Strategy
- Adopt a restrictive transfusion strategy, generally using a hemoglobin threshold of 7 g/dL in ICU patients.
- Prepare blood products in advance but avoid unnecessary transfusions unless bleeding is active or the patient is ischemic.