Skip to main content
SpringerLink
Log in

Anémie de réanimation : physiopathologie et prise en charge

Anaemia of the critically ill patients: pathophysiology and management

  • Mise au Point / Update
  • Published:
Réanimation

Résumé

L’anémie de réanimation est une pathologie fréquente, concernant près de 80 % des patients, et associée à une morbimortalité importante. Sa physiopathologie repose sur un défaut de synthèse et d’effet de l’érythropoïétine et sur des perturbations majeures du métabolisme du fer. Une meilleure connaissance de ce métabolisme et de sa régulation par l’hepcidine offre de nouvelles pistes thérapeutiques. Pour le moment, une attention particulière aux spoliations sanguines et une prescription individualisée de la transfusion sanguine sont les principaux éléments de la prise en charge.

Abstract

Anaemia is frequent in the critically ill patients, present in almost 80% of them. Anaemia is associated with worse outcome and increased mortality. Its pathophysiology combines disturbances of erythropoietin synthesis and iron metabolism. The better understanding of iron metabolism regulation by the hormone hepcidin may offer new therapeutic perspectives. However, to date, anaemia management requires mainly prevention of blood spoliations, mainly by reducing blood sampling, and tailored blood transfusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Vincent JL, Baron JF, Reinhart K, et al (2002) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507

    Article  PubMed  Google Scholar 

  2. Corwin HL, Gettinger A, Pearl RG, et al (2004) The CRIT Study: Anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med 32:39–52

    Article  PubMed  Google Scholar 

  3. Hebert PC, Wells G, Blajchman MA, et al (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 340:409–417

    Article  PubMed  CAS  Google Scholar 

  4. XXXIIIe conférence de consensus en réanimation et médecine d’urgence (2003) Transfusion érythrocytaire en réanimation (nouveau-né exclu). http://wwwsfarorg/s/articlephp3?id_article=250

    Google Scholar 

  5. Walsh TS, Lee RJ, Maciver CR, et al (2006) Anemia during and at discharge from intensive care: the impact of restrictive blood transfusion practice. Intensive Care Med 32:100–109

    Article  PubMed  Google Scholar 

  6. Bateman AP, McArdle F, Walsh TS (2009) Time course of anemia during six months follow up following intensive care discharge and factors associated with impaired recovery of erythropoiesis. Crit Care Med 37:1906–1912

    Article  PubMed  Google Scholar 

  7. Lasocki S, Longrois D, Montravers P, et al (2011) Hepcidin and anemia of the critically ill patient. Anesthesiology 114: 688–694

    Article  PubMed  Google Scholar 

  8. van Iperen CE, Gaillard CA, Kraaijenhagen RJ, et al (2000) Response of erythropoiesis and iron metabolism to recombinant human erythropoietin in intensive care unit patients. Crit Care Med 28:2773–2778

    Article  PubMed  Google Scholar 

  9. von Ahsen N, Muller C, Serke S, et al (1999) Important role of nondiagnostic blood loss and blunted erythropoietic response in the anemia of medical intensive care patients. Crit Care Med 27:2630–2639

    Article  Google Scholar 

  10. Robinson Y, Hostmann A, Matenov A, et al (2006) Erythropoiesis in multiply injured patients. J Trauma 61:1285–1291

    Article  PubMed  Google Scholar 

  11. Wu JC, Livingston DH, Hauser CJ, et al (2001) Trauma inhibits erythroid burst-forming unit and granulocyte-monocyte colonyforming unit growth through the production of TGF-beta1 by bone marrow stroma. Ann Surg 234:224–232

    Article  PubMed  CAS  Google Scholar 

  12. Claessens YE, Fontenay M, Pene F, et al (2006) Erythropoiesis abnormalities contribute to early-onset anemia in patients with septic shock. Am J Respir Crit Care Med 174:51–57

    Article  PubMed  CAS  Google Scholar 

  13. Weiss G, Goodnough LT (2005) Anemia of chronic disease. N Engl J Med 352:1011–1023

    Article  PubMed  CAS  Google Scholar 

  14. Rogiers P, Zhang H, Leeman M, et al (1997) Erythropoietin response is blunted in critically ill patients. Intensive Care Med 23:159–162

    Article  PubMed  CAS  Google Scholar 

  15. Beaumont C, Canonne-Hergaux F (2005) [Erythrophagocytosis and recycling of heme iron in normal and pathological conditions; regulation by hepcidin]. Transfus Clin Biol 12:123–130

    Article  PubMed  CAS  Google Scholar 

  16. Moldawer LL, Marano MA, Wei H, et al (1989) Cachectin/tumor necrosis factor-alpha alters red blood cell kinetics and induces anemia in vivo. Faseb J 3:1637–1643

    PubMed  CAS  Google Scholar 

  17. Piagnerelli M, Boudjeltia KZ, Brohee D, et al (2003) Modifications of red blood cell shape and glycoproteins membrane content in septic patients. Adv Exp Med Biol 510:109–114

    Article  PubMed  CAS  Google Scholar 

  18. Torti FM, Torti SV (2002) Regulation of ferritin genes and protein. Blood 99:3505–3516

    Article  PubMed  CAS  Google Scholar 

  19. Ganz T (2003) Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood 102:783–788

    Article  PubMed  CAS  Google Scholar 

  20. Nemeth E, Tuttle MS, Powelson J, et al (2004) Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science 306:2090–2093

    Article  PubMed  CAS  Google Scholar 

  21. Nemeth E, Rivera S, Gabayan V, et al (2004) IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J Clin Invest 113:1271–1276

    PubMed  CAS  Google Scholar 

  22. Darveau M, Denault AY, Blais N, et al (2004) Bench-to-bedside review: iron metabolism in critically ill patients. Crit Care 8:356–362

    Article  PubMed  Google Scholar 

  23. Lasocki S, Baron G, Driss F, et al (2010) Diagnostic accuracy of serum hepcidin for iron deficiency in critically ill patients with anemia. Intensive Care Med 36:1044–1048

    Article  PubMed  CAS  Google Scholar 

  24. Lasocki S, Millot S, Andrieu V, et al (2008) Phlebotomies or erythropoietin injections allow mobilization of iron stores in a mouse model mimicking intensive care anemia. Crit Care Med 36: 2388–2394

    Article  PubMed  CAS  Google Scholar 

  25. Burnum JF (1986) Medical vampires. N Engl J Med 314:1250–1251

    Article  PubMed  CAS  Google Scholar 

  26. Smoller BR, Kruskall MS (1986) Phlebotomy for diagnostic laboratory tests in adults. Pattern of use and effect on transfusion requirements. N Engl J Med 314:1233–1235

    CAS  Google Scholar 

  27. Alazia M, Colavolpe JC, Botti G, et al (1996) [Blood loss from diagnostic laboratory tests performed in intensive care units. Preliminary study]. Ann Fr Anesth Reanim 15:1004–1007

    Article  PubMed  CAS  Google Scholar 

  28. Lyon AW, Chin AC, Slotsve GA, et al (2013) Simulation of repetitive diagnostic blood loss and onset of iatrogenic anemia in critical care patients with a mathematical model. Comput Biol Med 3:84–90

    Article  Google Scholar 

  29. Rodriguez RM, Corwin HL, Gettinger A, et al (2001) Nutritional deficiencies and blunted erythropoietin response as causes of the anemia of critical illness. J Crit Care 16:36–41

    Article  PubMed  CAS  Google Scholar 

  30. Fernandez R, Tubau I, Masip J, et al (2010) Low reticulocyte hemoglobin content is associated with a higher blood transfusion rate in critically ill patients: a cohort study. Anesthesiology 112:1211–1215

    Article  PubMed  CAS  Google Scholar 

  31. Nicolas G, Chauvet C, Viatte L, et al (2002) The gene encoding the iron regulatory peptide hepcidin is regulated by anemia, hypoxia, and inflammation. J Clin Invest 110:1037–1044

    PubMed  CAS  Google Scholar 

  32. Pak M, Lopez MA, Gabayan V, et al (2006) Suppression of hepcidin during anemia requires erythropoietic activity. Blood 108:3730–3735

    Article  PubMed  CAS  Google Scholar 

  33. Vokurka M, Krijt J, Sulc K, et al (2006) Hepcidin mRNA levels in mouse liver respond to inhibition of erythropoiesis. Physiol Res 55:667–674

    PubMed  CAS  Google Scholar 

  34. Bellamy MC, Gedney JA (1998) Unrecognised iron deficiency in critical illness. Lancet 352:1903

    Article  PubMed  CAS  Google Scholar 

  35. Thomas C, Kirschbaum A, Boehm D, et al (2006) The diagnostic plot: a concept for identifying different states of iron deficiency and monitoring the response to epoetin therapy. Med Oncol 23:23–36

    Article  PubMed  CAS  Google Scholar 

  36. Brugnara C (2003) Iron deficiency and erythropoiesis: new diagnostic approaches. Clin Chem 49:1573–1578

    Article  PubMed  CAS  Google Scholar 

  37. Labbe RF, Dewanji A (2004) Iron assessment tests: transferrin receptor vis-a-vis zinc protoporphyrin. Clin Biochem 37:165–174

    Article  PubMed  CAS  Google Scholar 

  38. Auerbach M, Ballard H, Glaspy J (2007) Clinical update: intravenous iron for anaemia. Lancet 369:1502–1504

    Article  PubMed  Google Scholar 

  39. Cheng PP, Jiao XY, Wang XH, et al (2010) Hepcidin expression in anemia of chronic disease and concomitant iron-deficiency anemia. Clin Exp Med 11:33–42

    Article  PubMed  Google Scholar 

  40. Kroot JJ, Tjalsma H, Fleming RE, et al (2011) Hepcidin in human iron disorders: diagnostic implications. Clin Chem 57: 1650–1669

    Article  PubMed  CAS  Google Scholar 

  41. Piagnerelli M, Vincent JL (2004) Role of iron in anaemic critically ill patients: it’s time to investigate! Crit Care 8:306–307

    Article  PubMed  Google Scholar 

  42. Gabriel A, Kozek S, Chiari A, et al (1998) High-dose recombinant human erythropoietin stimulates reticulocyte production in patients with multiple organ dysfunction syndrome. J Trauma 44:361–367

    Article  PubMed  CAS  Google Scholar 

  43. Corwin HL, Gettinger A, Rodriguez RM, et al (1999) Efficacy of recombinant human erythropoietin in the critically ill patient: a randomized, double-blind, placebo-controlled trial. Crit Care Med 27:2346–2350

    Article  PubMed  CAS  Google Scholar 

  44. Corwin HL, Gettinger A, Pearl RG, et al (2002) Efficacy of recombinant human erythropoietin in critically ill patients: a randomized controlled trial. JAMA 288:2827–2835

    Article  PubMed  CAS  Google Scholar 

  45. Corwin HL, Gettinger A, Fabian TC, et al (2007) Efficacy and safety of epoetin alfa in critically ill patients. N Engl J Med 357:965–976

    Article  PubMed  CAS  Google Scholar 

  46. Georgopoulos D, Matamis D, Routsi C, et al (2005) Recombinant human erythropoietin therapy in critically ill patients: a doseresponse study [ISRCTN48523317]. Crit Care 9:R508–515

    Article  PubMed  Google Scholar 

  47. Vincent JL, Spapen HD, Creteur J, et al (2006) Pharmacokinetics and pharmacodynamics of once-weekly subcutaneous epoetin alfa in critically ill patients: results of a randomized, doubleblind, placebo-controlled trial. Crit Care Med 34:1661–1667

    Article  PubMed  CAS  Google Scholar 

  48. Zarychanski R, Turgeon AF, McIntyre L, et al (2007) Erythropoietin-receptor agonists in critically ill patients: a meta-analysis of randomized controlled trials. CMAJ 177:725–734

    Article  PubMed  Google Scholar 

  49. Silver M, Corwin MJ, Bazan A, et al (2006) Efficacy of recombinant human erythropoietin in critically ill patients admitted to a long-term acute care facility: a randomized, double-blind, placebo-controlled trial. Crit Care Med 34:2310–2316

    Article  PubMed  CAS  Google Scholar 

  50. Heming N, Montravers P, Lasocki S (2011) Iron deficiency in critically ill patients: highlighting the role of hepcidin. Crit Care 15:210

    Article  PubMed  Google Scholar 

  51. Lasocki S, Garnier M, Ley L, et al (2008) [How is iron prescribed in French ICUs: a practice survey]. Ann Fr Anesth Reanim 27:909–914

    Article  PubMed  CAS  Google Scholar 

  52. Heming N, Letteron P, Driss F, et al (2012) Efficacy and toxicity of intravenous iron in a mouse model of critical care anemia. Crit Care Med 40:2141–2148

    Article  PubMed  CAS  Google Scholar 

  53. Pieracci FM, Henderson P, Rodney JR, et al (2009) Randomized, double-blind, placebo-controlled trial of effects of enteral iron supplementation on anemia and risk of infection during surgical critical illness. Surg Infect (Larchmt) 10:9–19

    Article  Google Scholar 

  54. Notebaert E, Chauny JM, Albert M, et al (2007) Short-term benefits and risks of intravenous iron: a systematic review and metaanalysis. Transfusion 47:1905–1918

    Article  PubMed  CAS  Google Scholar 

  55. Harber CR, Sosnowski KJ, Hegde RM (2006) Highly conservative phlebotomy in adult intensive care—a prospective randomized controlled trial. Anaesth Intensive Care 34:434–437

    PubMed  CAS  Google Scholar 

  56. Foulke GE, Harlow DJ (1989) Effective measures for reducing blood loss from diagnostic laboratory tests in intensive care unit patients. Crit Care Med 17:1143–1145

    Article  PubMed  CAS  Google Scholar 

  57. Malone DL, Dunne J, Tracy JK, et al (2003) Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 54:898–905

    Article  PubMed  Google Scholar 

  58. Carson JL, Carless PA, Hebert PC (2013) Outcomes using lower vs higher hemoglobin thresholds for red blood cell transfusion. JAMA 309:83–84

    Article  PubMed  CAS  Google Scholar 

  59. Napolitano LM, Kurek S, Luchette FA, et al (2009) Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. Crit Care Med 37:3124–3157

    Article  PubMed  Google Scholar 

  60. Vincent JL, Sakr Y, Sprung C, et al (2008) Are blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study. Anesthesiology 108:31–39

    Article  PubMed  Google Scholar 

  61. Sakr Y, Lobo S, Knuepfer S, et al (2010) Anemia and blood transfusion in a surgical intensive care unit. Crit Care 14:R92

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. LUNAM Université, Université d’Angers, CHU d’Angers, pôle d’anesthésie-réanimation, CHU Angers, 4 rue Larrey, F-49933, Angers cedex 9, France

    S. Lasocki, T. Gaillard & E. Rineau

Authors
  1. S. Lasocki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Gaillard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Rineau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Lasocki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lasocki, S., Gaillard, T. & Rineau, E. Anémie de réanimation : physiopathologie et prise en charge. Réanimation 22, 366–372 (2013). https://doi.org/10.1007/s13546-013-0695-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13546-013-0695-6

Mots clés

Keywords

Search

Navigation