Effects of erythropoietin on anemia and need for transfusion

促红细胞生成素对贫血和输血需求的影响

• 批准号: 7551879
• 负责人: Alex Valadka
• 金额: $ 17.19万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7551879
• 关键词: Accounting; Acute; Adult Respiratory Distress Syndrome; Adverse effects; Allogenic; Anemia; Area; Behavior assessment; Blood; Blood Transfusion; Blood Vessels; Blood specimen; Bone Marrow; Brain; Brain Injuries; Cardiovascular Diseases; Carrying Capacities; Cause of Death; Cells; Cerebrovascular Circulation; Cerebrum; Clinical; Clinical Research; Clinical Trials; Complex; Critical Care; Critical Illness; Disease; Erythrocytes; Erythropoiesis; Erythropoietin; Functional disorder; Goals; Grant; Half-Life; Hematocrit procedure; Hemoglobin; Hemorrhage; Homeostasis; Immune; Incidence; Infection; Inflammatory; Injury; Intracranial Hypertension; Intracranial Pressure; Investigation; Laboratories; Life; Logic; Malignant Neoplasms; Mediator of activation protein; Neurologic; Neurological outcome; Neuropsychology; Numbers; Observational Study; Outcome; Oxygen; Oxygen measurement, partial pressure, arterial; Packed Red Blood Cell Transfusion; Pathology; Patients; Play; Population; Process; Prospective Studies; Public Health; Pulmonary Edema; Randomized Controlled Clinical Trials; Reaction; Recovery; Research; Research Personnel; Risk; Role; Saline; Severities; TBI Patients; Time; Transfusion; Transgenic Animals; Trauma; Traumatic Brain Injury; Unemployment; Vasodilation; Vasodilation disorder; Work; age group; brain tissue; cerebrovascular; gain of function; hemodynamics; improved; injured; neuropathology; novel; pressure; prevent; programs; receptor; recombinant human erythropoietin; response

Administration of recombinant human erythropoietin (rhEpo) stimulates erythropoiesis and increases red Dlood cell half-life, resulting in an increased hematocrit and potentially reducing the need for allogeneic blood transfusions in the critically ill patient. The original impetus for this project was to be able to control for these ystemic effects of rhEpo administration when examining the effects of rhEpo on cerebrovascular dysfunction in PROJECT 1. However, these effects on the occurrence and severity of anemia and on the need for blood transfusions may actually have equal or greater importance for long-term outcome than the neuroprotective effects. Patients with severe traumatic brain injury (TBI), like all critically ill patients, commonly develop anemia during the acute recovery period. Anemia after severe trauma is the result of a complex interaction of Dleeding, blunted Epo response to low hemoglobin concentrations, inflammatory mediators, and a hypoferremic state. Anemia requires the injured brain to maintain a higher cerebral blood flow (CBF) to maintain the same level of oxygen delivery. Cerebrovascular dysfunction caused by the trauma may prevent an adequate increase in CBF, which is the normal compensatory mechanism for a reduced oxygen-carrying capacity. Even if CBF does increase to maintain cerebral oxygen delivery, the resulting cerebral vasodilatation required to achieve the increase in CBF may result in an increased intracranial pressure (ICP). To optimize cerebral oxygenation in critically ill brain-injured patients, it is commonly recommended that hemoglobin concentration be maintained at approximately 10 g/dl. However, there is very little evidence that this practice actually improves cerebral hemodynamics or oxygenation, and maintaining hematocrit at this level commonly requires transfusion of blood products which may have significant risk. Trauma is the most common cause of death in the 1-44 yr age group, and the third most common cause for the entire US population. Trauma accounts for more loss of work life-years than cancer and cardiovascular diseases combined. Effective treatments for this important public health disorder are needed. We propose to study the role that erythropoietin administration might play in maintaining cerebral oxygenation after TBI. The specific aims include the following: 1-To study the role of anemia of critical illness on brain oxygenation and cerebral hemodynamics (including ICP) after TBI. 2-To study the complications associated with transfusion of blood products in patients with TBI. 3-To study the role of rhEpo administration on reducing the need for blood transfusion after TBI.

施用重组人促红细胞生成素 (rhEpo) 可刺激红细胞生成并增加红细胞 血细胞半衰期，导致血细胞比容增加，并可能减少对同种异体血液的需求 危重病人的输血。这个项目的最初动力是能够控制这些 研究 rhEpo 对脑血管的影响时给予 rhEpo 的系统影响 项目 1 中的功能障碍。然而，这些影响对贫血的发生和严重程度以及对 对于长期结果来说，输血的需要实际上可能与输血的需要同等或更重要。 神经保护作用。 与所有危重患者一样，严重创伤性脑损伤 (TBI) 患者通常会出现贫血 在急性恢复期。严重创伤后贫血是以下因素复杂相互作用的结果 对低血红蛋白浓度、炎症介质和 低铁血症状态。贫血需要受伤的大脑维持较高的脑血流量（CBF） 保持相同水平的氧气输送。外伤引起的脑血管功能障碍可能会预防 CBF 的充分增加，这是携氧量减少的正常补偿机制 容量。即使 CBF 确实增加以维持脑供氧，由此产生的脑 增加 CBF 所需的血管舒张可能会导致颅内压 (ICP) 升高。 为了优化危重脑损伤患者的脑氧合，通常建议： 血红蛋白浓度维持在大约 10 g/dl。然而，很少有证据表明 这种做法实际上可以改善脑血流动力学或氧合，并保持血细胞比容 水平通常需要输注可能具有重大风险的血液制品。 创伤是 1-44 岁年龄段最常见的死亡原因，也是第三大常见原因 为全体美国人口。创伤造成的工作年数损失比癌症和 合并心血管疾病。这种重要的公共卫生疾病需要有效的治疗方法。 我们建议研究促红细胞生成素给药在维持脑功能方面可能发挥的作用 TBI 后的氧合。具体目标包括以下内容： 1-研究危重患者贫血的作用 TBI 后疾病对脑氧合和脑血流动力学（包括 ICP）的影响。 2-研究 TBI 患者输血相关的并发症。 3、研究角色的作用 rhEpo 给药可减少 TBI 后输血的需要。