Patient Blood Management for the Critically-Ill Patient

Purpose of the Review: Anemia in the critically ill is both insidious and highly prevalent; and has been implicated in poor outcomes in patients with and recovering from critical illness. Patient-oriented approaches to blood management (PBM) are gaining momentum and have widespread applications as a superior approach to anemia. The volume of publications pertaining to PBM has dramatically increased in the past 4 years, warranting further review of emerging paradigms in the ICU. Recent Findings: IV iron alone and in conjunction with erythropoietin are being studied prospectively. Factor concentrates are used more frequently, and both point of care and viscoelastic testing algorithms have been shown to reduce utilization of blood products. Both whole blood and thrombopoietin also show promise in reducing transfusions. Summary: Careful attention to PBM approaches has the potential to improve the quality and reduce the cost of care of patients in the ICU. Significant work remains, especially in the areas of education of care teams on the importance of reducing phlebotomy and updating knowledge of current indications for therapies aimed at increasing hemoglobin levels and reducing blood product transfusions.