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Causes of anemia in critical illness. Hemorrhage is often the primary factor. Hemolysis is increased by pathogens and immune mediators. Proinflammatory cytokines such as interleukin 1 (IL-1) and tumor necrosis factor α (TNF-α) suppress EPO expression and inhibit the proliferation of erythrocytic progenitors. The iron availability is greatly reduced by the acute-phase protein hepcidin.
