Mortality Associated Parameters With Inflammatory Anemia in Patients With Sepsis Admitted to the Intensive Care Unit and Blood Transfusion Effect

Anemia is one of the most common complications in patients with sepsis in the intensive care unit (ICU), as well as sepsis is a major cause of high mortality in ICU. Studies demonstrated that sepsis-related anemia can be caused by fluid loading related hemodilution, iatrogenic blood loss, decreases in iron supply, erythropoietin (EPO) production and erythrocyte lifespan .

However, sepsis related anemia has been demonstrated to be associated mainly with inflammation (i.e., "anemia of inflammation"). Anemia of inflammation is usually a mild to moderately severe anemia (hemoglobin rarely < 8 g/dL) . It develops in the setting of infection, inflammatory disease or malignancy, together with low serum iron despite adequate systemic iron stores, decreased serum transferrin, normal size of erythrocytes and hemoglobin content or mildly decreased size and hemoglobin content of erythrocytes if the inflammatory disease is longstanding .

Impaired iron homeostasis and the suppressive effects of proinflammatory cytokines on erythropoiesis, together with alterations in the erythrocyte membrane that impair its survival may result, ultimately, in inflammation-associated anemia .

Hepcidin is a key regulator of inflammation-associated anemia. Hepcidin reduces the iron level in plasma through:

1. direct inhibition of intestinal absorption of iron.
2. promotion of iron storage in macrophages by down regulating expression of ferroprotein in intestinal mucosae and macrophages.