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: 8013930
• 负责人: Alex Valadka
• 金额: $ 49.71万
• 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 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8013930
• 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; Inflammation Mediators; Injury; Intracranial Hypertension; Intracranial Pressure; Investigation; Laboratories; Life; Logic; Malignant Neoplasms; Neurological outcome; Neuropsychology; 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; Reaction; Recovery; Research; Research Personnel; Risk; Role; Saline; Severities; TBI Patients; Time; Transfusion; Transgenic Animals; Trauma; Traumatic Brain Injury; Unemployment; Vasodilation; Work; adverse outcome; age group; blood product; brain tissue; cerebrovascular; effective therapy; gain of function; hemodynamics; improved; injured; neurological recovery; neuropathology; novel; pressure; prevent; programs; randomized trial; 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.

重组人红细胞生成素（RHEPO）刺激红细胞生成并增加红色 DLOOD细胞半衰期，导致血细胞比容增加，并有可能减少对同种异体血液的需求 重症患者的输血。该项目的原始动力是能够控制这些 RHEPO给药的系统效应在检查RHEPO对脑血管的影响时 但是，项目1中的功能障碍。但是，这些对贫血的发生和严重程度以及对 与长期结果相比 神经保护作用。 与所有重症患者一样 在急性恢复期间。严重创伤后的贫血是复杂相互作用的结果 对低血红蛋白浓度，炎症介质和A 低血压状态。贫血需要受伤的大脑才能维持更高的脑血流（CBF） 保持相同水平的氧气输送。受创伤引起的脑血管功能障碍可能会阻止 CBF的足够增加，这是减少氧气携带的正常补偿机制 容量。即使CBF确实增加以维持脑氧递送，也会产生的大脑 实现CBF增加所需的血管扩张可能会导致颅内压增加（ICP）。 为了优化严重恶性脑损伤患者的脑充氧，通常建议您 血红蛋白浓度保持在约10 g/dL。但是，几乎没有证据表明 这种做法实际上改善了脑血液动力学或氧合，并在此维持血细胞比容 水平通常需要输血可能具有重大风险的血液产品。 创伤是1-44岁年龄段的最常见死亡原因，也是第三大的原因 对于整个美国人口。创伤占工作年寿命损失的损失比癌症和 心血管疾病的总和。需要有效治疗这种重要的公共卫生障碍。 我们建议研究促红细胞生成素可能在维持脑中发挥的作用 TBI后的氧合。具体目的包括以下内容：1前研究关键的贫血的作用 TBI之后的脑氧合和脑血液动力学（包括ICP）的疾病。 2对 与TBI患者中血液产物输血有关的并发症。 3-研究角色 RHEPO在减少TBI后减少输血的需求。