tailieunhanh - Oxford Handbook of Critical Care - part 8

Hủy bỏ đồng hồ và lery viên ngọc quý, loại bỏ áo khoác dài tay áo trắng và áo jacket, rol l áo sơ mi tay áo lên đến khuỷu tay Rửa tay và cẳng tay trước và sau khi tiếp xúc bệnh nhân Mặc tạp dề và găng tay dùng một lần nếu tiếp xúc với bệnh nhân | possibly a decreased lifespan Rarer causes include Microcytic anaemia predominantly iron deficiency Normocytic Chronic disease Bone marrow failure idiopathic drugs neoplasm radiation Haemolysis Renal failure Macrocytic vitamin B12 and folate deficiency alcoholism cirrhosis sideroblastic anaemia hypothyroidism Congenital diseases sickle cell thalassaemia Management 1. Treatment of the cause where possible. 2. Blood transfusion The ideal haemoglobin level for optimal oxygen carriage and viscosity remains contentious. A recent multicentre trial showed improved outcomes if a trigger of 7 g dl was used. A higher transfusion threshold . 9-10 g dl may be needed in those with cardiorespiratory disease. Transfusion is usually given as packed cells with or without a small dose of furosemide to maintain fluid balance. This may need to be given rapidly during active blood loss or slowly for correction of a gradually falling haemoglobin level. Rarely patients admitted with a chronically low haemoglobin . 4-5 g dl which often follows long term malnutrition or vitamin deficiency will need a much slower elevation in haemoglobin level to avoid precipitating acute heart failure. An initial target of 7-8 g dl is often acceptable. Obviously this may need to be altered in the light of any concurrent acute illness where elevation of oxygen delivery is deemed necessa ry. Erythropoeitin reduces the need for blood transfusion in long-term ICU patients and may be useful in those with multiple antibodies or declining transfusion for religious reasons. Key trial Hebert PC et al for the Transfusion Requirements in Critical Care Investigators Canadian Critical Care Trials Group. A multicenter randomized controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999 340 409-17 Sickle cell disease A chronic hereditary disease almost entirely confined to the black population where the gene for Hb S is inherited from each parent. The red blood cells .