In March 2007, the FDA issued a black-box warning for erythropoiesis-stimulating agents. It is recommended that the lowest possible dose be used to help patients avoid blood transfusions. Studies have shown increased mortality and/or a tumor progression in patients with cancer receiving an erythropoiesis-stimulating agent.
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Anemia is common among critically ill patients, affecting 29%–77% depending on the report. In such patients, common comorbidities such as multiple-organ failure, sepsis, myocardial ischemia, pulmonary edema, and others can severely affect normal compensatory mechanisms and severely diminish their ability to tolerate even mild degrees or short durations of anemia. Therefore, anemia management in this population is aimed at the early detection of risk factors and the prompt institution of evidence-based therapies.
Although the transfusion of blood products has traditionally been the mainstay of treatment, indiscriminate transfusion is expensive, costing at an estimated $300–$1000 per unit. More important, new evidence suggests that blood transfusion and its complications may actually increase, not reduce, a patient’s risk of mortality. The transfusion of blood products is associated with a host of infectious and noninfectious complications, such as bacterial and viral infections, immune modulation, transfusion-related lung acute lung injury, and iatrogenic conditions due to human error. Another problem is the lack of clearly defined transfusion triggers. Although current triggers range between 70 and 100 g/L (7.0–10.0 g/dL), optimal thresholds for critically ill patients are unknown.
The entire field of critical care has dramatically advanced in recent years, and transfusion practices must evolve as well. Effective alternatives or adjuncts in managing anemia now include erythropoietic agents, iron therapy, and blood conservation, among other options. Awareness of the human and economic costs of unmanaged or undermanaged anemia in critically ill patients and an appreciation of the risk and benefits of blood transfusion and available alternatives will greatly improve patient care. This program will help cardiopulmonary and critical care specialists who treat patients at risk for anemia to recognize the life and cost benefits of early detection and intervention, to understand
A clinical discussion with Melissa Means-Markwell, MD, FACP, FACCP, and Patricia Wilson, BSN, RN
In this engaging discussion, Dr. Means-Markwell discusses the importance of considering the risks and benefits of transfusion in critically ill patients with anemia to select the most appropriate course of therapy.
This self-study activity should be completed in approximately 60 minutes.
We invite you to join Howard L. Corwin, MD, Medical Director of the Intensive Care Unit at the Dartmouth-Hitchcock Medical Center, Lebanon, NH, to discuss the risks and benefits associated with RBC transfusion in critically ill patients. He reviews transfusion strategies in the critically ill and alternatives to RBC transfusion.
This self-study activity should be completed in approximately 60 minutes.
This interactive course discusses the development of anemia in ICU patients and provides some highly practical tools that you can immediately implement in your clinical setting to assess your patients’ risk of anemia and to determine if treatment is indicated.
This self-study activity should be completed in approximately 30 minutes.
This interactive course discusses the development of anemia in ICU patients and provides some highly practical tools that you can immediately implement in your clinical setting to assess your patients’ risk of anemia and to determine if treatment is indicated.
This self-study activity should be completed in approximately 15 minutes.
Clinicians should routinely and consistently screen their patients to identify those at highest risk and then initiate appropriate therapies as early as possible. This module provides some highly practical tools that you can immediately implement in your clinical setting to assess your patients’ risk of anemia and to determine if treatment is indicated.
This self-study activity should be completed in approximately 15 minutes.
Through a review of recent evidence-based data, this course presents up-to-date information about the infections and physiologic problems associated with the use of blood products and describes steps to limit those risks.
This self-study activity should be completed in approximately 15 minutes.
Through a review of recent evidence-based data, this course presents up-to-date information about the infections and physiologic problems associated with the use of blood products and describes steps to limit those risks.
This self-study activity should be completed in approximately 15 minutes.
Through a review of recent evidence-based data, this course presents up-to-date information about the infections and physiologic problems associated with the use of blood products and describes steps to limit those risks.
This self-study activity should be completed in approximately 30 minutes.
In a real-life case scenario, put your skills and evidence-based knowledge to work by assessing the patient’s risk for anemia, selecting the best treatment option, adjusting treatment according to the patient’s response, and planning follow-up care.
This self-study activity should be completed in approximately 60 minutes.
In this engaging and interactive Web workshop, Dr. Leo Rotello, MD will use a problem-based learning approach to present a case scenario based on a real, critically ill patient with risk factors for anemia.
This self-study activity should be completed in approximately 60 minutes.
This CME activity is designed for critical care physicians, critical care nurses, and other healthcare providers who treat patients with risk factors for anemia.
Accreditation Statement MEBN is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
CME Credits MEBN designates this educational activity for a maximum of 6 AMA PRA Category I Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
FDA Disclosure Statement The contents of some CME activities may contain discussions of non-approved or off-label uses of some of the agents mentioned. Please consult the prescribing information for full disclosure of approved uses.
Accreditation Period Original release date: March 23, 2006 Reviewed and Renewed: March 23, 2008 Expiration Date: March 23, 2009
Any questions regarding the accreditation of this CME activity should be directed to MEBN. (accreditation@mebn.net)
Continuing Education for Nurses MEBN is approved as a provider of continuing education in nursing by the New Hampshire Nurses’ Association Commission on Continuing Education, which is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. MEBN recognizes that the accredited status refers only to our continuing nursing education activities and does not imply that the ANCC Commission on Accreditation approves or endorses these commercial products.
Contact Hours MEBN designates this continuing education activity for up to 6 contact hour(s) of nursing continuing education credit.
Accreditation Period Original release date: March 23, 2006 Reviewed and Renewed: March 23, 2008 Expiration Date: March 23, 2009
Disclaimer This continuing education program may
contain discussion of published and/or investigational uses of agents or
products that are not approved by the Food and Drug Administration (FDA). The
authors, sponsors or publishers do not recommend the use of any agent or product
outside of the official labeled indications. Please refer to the official
prescribing information for each agent or product for discussion of approved
indications, contraindications, and written warnings.
Any procedures, medications, or other courses of diagnosis or
treatment discussed or suggested in this course should not be used by clinicians
without evaluation of their patient's conditions and possible contraindications
on dangers in use, review of any applicable manufacturer's product information,
and comparison with recommendations of other authorities.
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CME-TODAY offers FREE continuing medical education (CME) credits to recipients of the CD-ROM or CME-TODAY journal. Enter the CE Code listed on the CD-ROM or in the journal when prompted. This free offer expires on May 1, 2008. All others will be assessed a $0.00 processing fee.
