Identification of Erythroid ProgenItor Defects in Critical IllnesS
Research type
Research Study
Full title
Identification of Erythroid ProgenItor Defects in Critical IllnesS (EPICS): a prospective observational study
IRAS ID
247682
Contact name
Akshay Shah
Contact email
Sponsor organisation
University of Oxford / Clinical Trials & Research Governance
Duration of Study in the UK
0 years, 12 months, 0 days
Research summary
Research Summary
At present, we have very few ways of determining which seriously ill patients in ICU will respond to treatment for anaemia (low number of red blood cells). This is important because red blood cells carry oxygen to vital body organs and reduced oxygen delivery can be detrimental.
The answer may lie in being able to assess how well the cells in the bone marrow are working. These cells turn into specific blood cells such as red blood cells to carry oxygen throughout the body, white blood cells to fight infection and platelets to control bleeding. We are particularly interested in the development and function of red blood cells.
In order to better understand the function of the bone marrow in ICU patients, samples have been collected by performing a bone marrow biopsy - an invasive procedure that is painful and carries a small risk of bleeding However, newly developed laboratory techniques mean that it is possible to understand bone marrow function from a blood test. These techniques are also able to assess how well these cells are able to develop into red blood cells. In other groups of patients, these techniques have been successful in characterising bone marrow function and shown promise in improving treatments for anaemia.
In this study we wish to use these technique to better understand bone marrow function by recruiting 30 patients who have required ICU care for at least 3 days. We also wish to investigate what happens to bone marrow function after 1 month, whether or not it recovers and what factors (such as iron levels in the body) are associated with recovery.
The findings of this research has the potential to help improve our understanding of erythropoiesis in critical illness and help identify which ICU patients are mostly likely to benefit from anaemia treatments.
Summary of Results
Anaemia (low number of red blood cells or ‘low blood count’) is a very common problem in intensive care unit (ICU) patients. At present, we have very few ways of determining which seriously ill patients in ICU will respond to treatment for anaemia (low number of red blood cells). This is important because red blood cells carry oxygen to vital body organs and reduced oxygen delivery can be detrimental. The answer may lie in being able to assess how well the cells in the bone marrow are working. These cells turn into specific blood cells such as red blood cells to carry oxygen throughout the body, white blood cells to fight infection and platelets to control bleeding. We are particularly interested in the development and function of red blood cells.
To better understand the function of the bone marrow in ICU patients, samples have traditionally been collected by performing a bone marrow biopsy - an invasive procedure that is painful and carries a small risk of bleeding. However, newly developed laboratory techniques mean that it is possible to understand bone marrow function from a blood test. These techniques are also able to assess how well these cells can develop into red blood cells. In other groups of patients, these techniques have been successful in characterising bone marrow function and shown promise in improving treatments for anaemia.
In this study we wanted to see if it would be possible to use these techniques in ICU patients to better understand bone marrow function. We recruited 30 patients who required ICU care for at least 3 days. We collected blood samples at 3 days and around one month after. The patients we included in our study were broadly similar to those who are admitted to ICUs in the UK every year. To test if these techniques work, we measured a cell called CD34+ - this gives an idea of how well the bone marrow is working. We found that in all blood samples, we were able to measure enough CD34+ cells. We also found that when patients are seriously ill in ICU their bone marrow doesn’t work as effectively as healthy people. In one-month follow up blood samples, we found that bone marrow function recovers and that there is an inclination to produce more red blood cells. However, these cells are ‘immature’ and may require nutrients such as iron to develop.
We have shown that these laboratory techniques work on blood samples removing the need for invasive bone marrow biopsies. In addition, the findings of this research may mean that giving certain patients iron, either through a drip or as tablets, when are they are recovering from serious illness may lead to better health. We are now planning a bigger study to see if our approach is scalable and whether we can personalise treatments for anaemia in patients recovering from a critical illness.
REC name
South Central - Oxford C Research Ethics Committee
REC reference
18/SC/0545
Date of REC Opinion
2 Nov 2018
REC opinion
Favourable Opinion