| Preface: Hematologic Issues in the ICU | p. ix |
| Anemia in the ICU: Anemia of Chronic Disease Versus Anemia of Acute Illness | p. 333 |
| Anemia is common in the ICU, increasing morbidity and mortality. Its etiology is multifactorial but anemia of inflammation is the most common cause, followed closely by iron deficiency. The two conditions often coexist and it can be difficult to diagnose iron deficiency in the context of anemia of inflammation. Blood transfusions and use of erythropoietin agonists are two modalities used to correct anemia in critically ill patients. Randomized controlled trials have not supported the use of either therapy except in well defined clinical situations. Better understanding of the pathophysiology of anemia of inflammation may lead to development of novel therapies. | |
| The Use of Erythropoiesis-Stimulating Agents in the Intensive Care Unit | p. 345 |
| Anemia is common in critically ill patients, but treatment with red blood cell transfusions can have unwanted effects. Limiting the occurrence and severity of anemia by using erythropoietic agents (iron and/or recombinant erythropoietin), therefore, remains an attractive option during the intensive care unit stay but also after hospital discharge. Moreover, these agents may have additional beneficial properties. In this article the authors review the rationale for the administration of iron and/or erythropoietin in critically ill patients. | |
| Transfusion Reactions: Newer Concepts on the Pathophysiology, Incidence, Treatment, and Prevention of Transfusion-Related Acute Lung Injury | p. 363 |
| Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. TRALI presents as acute lung injury (ALI) within 6 hours after blood product transfusion. Diagnosing TRALI requires a high index of suspicion, and the exclusion of circulatory overload or other causes of ALL The pathophysiology of TRALI is incompletely understood, but in part involves transfusion of certain anti-neutrophil antibodies, anti-HLA antibodies, or other bioactive sub stances, into susceptible recipients. Recent studies have identified both recipient and transfusion risk factors for the development of TRALI. This article describes these TRALI risk factors, as well as diagnosis, treatment and prevention strategies. | |
| The Utility of a Diagnostic Scoring System for Disseminated Intravascular Coagulation | p. 373 |
| Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by microvascular thrombosis resulting from systemic activation of coagulation, and it should be diagnosed and treated as early as possible. No single test is sufficiently accurate to establish or rule out a diagnosis of DIC. Therefore, diagnostic scoring uses a combination of several laboratory tests. Three diagnostic scoring systems are now available and validated. Because it is not easy to assess the superiority or inferiority of these scoring systems, it may be better to select the scoring system depending on the need for an early or affirmative diagnosis of DIC. | |
| Intensive Care Unit Management of Liver-Related Coagulation Disorders | p. 389 |
| Coagulopathy, one of the cardinal features of advanced liver disease, is related to multiple factors including impaired synthetic function, thrombocytopenia, excessive fibrinolysis, platelet dysfunction, and disseminated intravascular coagulopathy. In the intensive care unit, management of coagulopathy may require treatment, particularly in the actively bleeding patient or in preparation for invasive procedures. This article reviews the background of coagulopathy in patients with end-stage liver disease and management options and comments on common clinical scenarios. | |
| Etiology and Significance of Thrombocytopenia in Critically III Patients | p. 399 |
| Thrombocytopenia is common in critically ill patients and increases morbidity and mortality. A diagnosis of heparin-induced thrombocytopenia (HIT) is frequently considered in any ICU patient who develops thrombocytopenia in the context of ongoing heparin exposure. As the usual tests to diagnose HIT are often neither specific nor sensitive enough to be confirmatory, the intensivist must largely rely on clinical judgment in treatment decisions. Patients in the ICU may also develop thrombocytopenia resulting from non-HIT immune mechanisms, non immune platelet consumption, and from decreased platelet production due to preexisting disorders or as a result of their critical illness and/or drug therapy. | |
| A Reappraisal of Plasma, Prothrombin Complex Concentrates, and Recombinant Factor Vila in Patient Blood Management | p. 413 |
| Plasma therapy and plasma products such as prothrombin complex concentrates (PCCs), and recombinant activated factor VII (rFVIIa) are used in the setting of massive or refractory hemorrhage. Their roles have evolved because of newly emerging options, variable availability, and heterogeneity in guidelines. These factors can be attributable to lack of evidence-based support for a defined role for plasma therapy, variability in coagulation factor content among PCCs, and uncertainty regarding safety and efficacy of rFVIIa in these settings. This review summarizes these issues and provides insight regarding use of these options in management of refractory or massive bleeding. | |
| Newer Anticoagulants in Critically III Patients | p. 427 |
| Critically ill patients are at increased risk for development of thrombosis. In addition, thrombosis is often unrecognized in this population. Furthermore, these patients are particularly susceptible to bleeding complications from anticoagulants. Herein the authors review the pharmacology, data from clinical trials, management of bleeding complications, and perioperative use of these agents in the intensive care unit population. Well-designed clinical trials are needed to improve our understanding of the safety and efficacy of these newer agents in critically ill patients. | |
| The Role of Plasmapheresis in Critical Illness | p. 453 |
| In this article, the authors review the current recommendations from the American Society for Apheresis regarding the use of plasmapheresis in many of the diseases that intensivists commonly encounter in critically ill patients. Recent experience indicates that therapeutic plasma exchange may be useful in a wide spectrum of illnesses characterized by microvascular thrombosis, the presence of autoantibodies, immune activation with dysregulation of immune response, and some infections. | |
| Index | p. 469 |
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