Anemia in critically ill patients has been described as an acute form of anemia of inflammatory disease and is characterized by a blunted erythropoietic response due in part to proinflammatory mediators. Management of anemia in critically ill patients is a complex issue and is best approached via a multiprofessional team regarding the use of allogenic blood, iron, nutritional therapy, and erythropoietic agents. Indiscriminant, ``routine'' red blood cell transfusions may not only be unnecessary, but may pose unnecessary risk to the intensive care unit patient. Most intensive care unit patients can tolerate lower hemoglobin/hematocrit concentrations than the typically accepted ``10/30 rule.'' Lower transfusion triggers with an overall transfusion strategy is warranted in the intensive care unit patient. The use of recombinant human erythropoietic agents may not be necessary with appropriate transfusion practices.
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