Erythropoietin in the Critically Ill

Introduction: Erythropoietin (EPO) is a recombinant human glycoprotein hormone that stimulates erythropoiesis. There is increasing experience in its use in management of anemia in the critically ill. Methods: This review focuses on clinical, experimental papers regarding erythropoietin usage in the critically ill from the Medline database. Data from our intensive care unit (ICU) were also included. Results: Anemia occurs commonly in the critically ill during ICU stay. Erythropoietin responses are blunted in MODS. EPO is an effective means of increasing haemoglobin and reduces blood transfusion. High doses 300-600U/kg of EPO produce erythropoietic responses within 6 days. For the general critical care patient, studies to date have not shown any increase in adverse events, nor any mortality benefit. Conclusion: Clinical indications include those in whom transfusion is difficult, such as Jehovah’s witnesses, or patients with antibodies. Data in the critically ill support the use of 600U/kg subcutaneously weekly for 4 weeks, with adjuvant therapy of oral iron 300mg/day, vitamin C 100mg/day, folate 5mg/day and possibly vitamin E. We recommend commencing when Hct is less than 30% in patients likely to remain in the ICU beyond one week. Patients should be monitored for hypertension and haemoglobin response. Erythropoietin use is now established as an efficacious, easy to use and safe method of treating anemia in the critically ill.