How are anemia and coagulopathy corrected in sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Hemoglobin levels as low as 7 g/dL are well tolerated by patients, and transfusion is not required unless the patient has poor cardiac reserve or demonstrates evidence of myocardial ischemia. Thrombocytopenia and coagulopathy are common in patients with sepsis; these patients do not require replacement with platelets or fresh frozen plasma (FFP) unless they develop active clinical bleeding.

If hemoglobin levels fall below 7 g/dL, red blood cell (RBC) transfusion is recommended to a target hemoglobin range of 7-9 g/dL. [11] Even in the absence of apparent bleeding, patients with sepsis should receive platelet transfusion if platelet counts fall below 10 × 109/L (10,000/µL). Platelet transfusion may also be considered when bleeding risk is increased and platelet counts are below 20 × 109/L (20,000/µL). [11] Patients who are to undergo surgery or other invasive procedures may require higher platelet counts (eg, ≥50 × 109/L [50,000/µL]).

Other points to consider with respect to the administration of blood products include the following [11, 60] :

  • Erythropoietin is not recommended for specific treatment of anemia associated with sepsis; rather, it should be given to such patients for other acceptable indications (eg, anemia associated with renal failure)

  • FFP is not recommended for the correction of laboratory clotting abnormalities unless bleeding is present or invasive procedures are planned

  • Antithrombin agents are not recommended for treatment of sepsis and septic shock

  • Recombinant activated protein C (rhAPC) is no longer available for treating patients with sepsis or septic shock


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