Continuing current management is appropriate. The patient is asymptomatic and displays no end-organ compromise as a result of reduced oxygen-carrying capacity. A randomized phase III study was performed in euvolemic patients whose hemoglobin level decreased to less than 9 g/dL (90 g/L) within 72 hours of admission to an ICU. Patients were assigned to a liberal transfusion strategy targeting a hemoglobin level of 10 to 12 g/dL (100-120 g/L), in which they were transfused when their hemoglobin level decreased to less than 10 g/dL (100 g/L), or a restrictive approach, in which they were transfused for a hemoglobin level less than 7 g/dL (70 g/L) (target 7-9 g/dL [70-90 g/L]). Mortality rates were at least as good for those assigned to the restrictive transfusion approach. However, a subset analysis revealed that patients with ischemic heart disease had a trend toward higher mortality with a restrictive transfusion practice that was not statistically significant, suggesting that patients with ischemic heart disease should be evaluated on a case-by-case basis until further phase III data dictate otherwise.

Although the patient has an elevated creatinine level, this is likely the result of sepsis and appears to be improving with volume repletion and correction of hypotension. As such, there is no role for an erythropoiesis-stimulating agent (ESA). Furthermore, ESAs have not been studied for this indication.

The patient has iron indices typical of an inflammatory anemia (low serum iron, low total iron-binding capacity, normal transferrin saturation, elevated ferritin), likely due to sepsis and not iron deficiency anemia (low serum iron, high-normal to high total iron-binding capacity, low transferrin saturation, low ferritin). Therefore, intravenous iron is not indicated.