集中治療室における貧血と薬物療法の課題

抄録

Anemia is highly prevalent in the intensive care unit, with hemoglobin levels below 10 g/dL observed in up to 98％ of patients. Persistent anemia after the intensive care unit discharge is associated with poor outcomes, including reduced home discharge rates, increased readmission, and higher mortality. While red blood cell transfusion remains the standard therapy for anemia management, it carries risks such as cardiovascular strain, transfusion-related lung injury, infection, and immune modulation. Restrictive transfusion strategies based on lower hemoglobin thresholds have been validated in large randomized controlled trials and are gaining broad consensus in international guidelines to minimize these risks. However, pharmacologic therapy for anemia in critically ill patients requires individualized decision-making that considers symptoms, clinical findings, laboratory data, and patient preferences. Pharmacologic therapies for anemia in critically ill patients, including erythropoiesis-stimulating agents and intravenous iron, have been evaluated in randomized trials and network meta-analyses, showing a favorable balance between efficacy and safety, particularly in reducing transfusion requirements without increasing thromboembolic risk. Despite this evidence, international guidelines provide inconsistent recommendations, and implementation in Japan faces barriers related to clinical practice patterns and reimbursement policies. This review summarizes the pathophysiology of anemia in critically ill patients, the evidence supporting pharmacologic interventions, and the discrepancies among guideline recommendations. Furthermore, it discusses contextual challenges to implementation and proposes strategies to enhance feasibility and acceptance in clinical practice.