eng Science and Education Publishing Global Journal of Surgery 2379-8750 2019-01-22 7 1 12 18 10.12691/js-7-1-3 JS2019713 article Michael Smits 1 Colby Hart 2 Gausihi Sivarajah 3 Matija Radojcic matijaradojcic@gmail.com 3 Saleh Abbas 4 Department of Surgery, Austin Health, Heidelberg, Victoria, Australia Department of Surgery, Alfred Health, Melbourne, Victoria, Australia Department of Surgery, St Vincent’s Hospital, Fitzroy, Melbourne, Australia Department of Surgery, University Hospital Geelong, Geelong, Australia Background: Inflammation in surgical sepsis and stress frequently causes anaemia, leading to increased rates of blood transfusions. Recent evidence shows that blood transfusions carry a greater risk for short- and long-term complications than previously thought. Objective: To review the role of erythropoietin (EPO), iron and/or steroids as an alternative treatment to blood transfusions in critically ill patients. Methodology: A systematic review was prepared from recent literature on inflammation-induced anaemia, anaemia in the critically ill and/or septic patient and the roles of EPO, iron and corticosteroids in these patients. A meta-analysis was completed for EPO. Results: Inflammatory cytokines alter haematopoietic and biochemical pathways, leading to anaemia. Inflammation decreases circulating EPO and upregulates hepcidin, resulting in decreased free iron. Twelve randomised-controlled trials demonstrate that EPO administration in critically ill patients reduces the need for blood transfusions by 31% (p=0.005) however does not significantly decrease mortality (p=0.15). Intravenous iron also reduces the need for blood transfusions but has not been utilised in sepsis-associated anaemia. No trials focusing on the effects of steroids on sepsis-associated anaemia were identified. Conclusion: Due to the lack of data specific to sepsis-associated anaemia in post-operative patients, the roles of EPO, iron and steroids remain under investigation. More research specific to surgical patients is needed. http://pubs.sciepub.com/js/7/1/3/js-7-1-3.pdf anaemia sepsis erythropoietin iron steroids