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Pharmacy Department Cité de la Santé de Laval 1755 boul René-Laennec Laval, Québec H7M-3L9, Canada fax 450/975-5354 martin_darveau{at}ssss.gouv.qc.ca
Critical Care Department Cité de la Santé de Laval
Published Online, May 25, 2004. www.theannals.com, DOI 10.1345/aph.1D368a
Indeed, we strongly believe that a restrictive transfusion approach is an important step to implementing a blood conservation strategy in critically ill patients and that the use of EPO without a restrictive transfusion approach will not be efficient. In our ICU, the Transfusion Medicine committee developed a tool to ensure an appropriate use of red blood cell transfusions. The tool is a prescription with printed recommendations for blood product administration. Among others, these recommendations specify that the prescription of red blood cell transfusions should be based on the clinical condition of the patient rather than on a single hematocrit or hemoglobin value. We ask the medical team to prescribe blood products based on that tool and to justify the reason of transfusion. We assume that this exercise will educate, change transfusion practice, and avoid unnecessary blood transfusion.
A review of the literature concerning the role of EPO in critically ill patients was also published 2 years ago in The Annals.3 When we revised this topic, the EPO -2 study conducted by Corwin et al.4 had not been published yet. We support Pajoumand et al.'s conclusion that optimal EPO dosage remains to be determined. It seems that higher doses of EPO could provide a higher erythropoiesis response during the ICU stay. More importantly, additional studies combining the use of EPO with a restrictive transfusion approach such as proposed in the TRICC (Transfusion Requirements in Critical Care) trial5,6 are needed.
Footnotes
Dr. Notebaert received a research grant from Ortho-Biotech.
Letters are subject to review prior to acceptance. They should address areas related to pharmacy practice, research, or education, or articles recently published. Corrections of previously published material also are accepted. Letters are limited to no more than five authors. In cases where adverse drug effects are described, the Naranjo ADR probability scale should be used to determine the likelihood that the adverse effect was drug-related (Clin Pharmacol Ther 1981;30:239-45). Text: limit 500 words. References: limit 5. Art: limit 1 table or figure.
References
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