PURPOSE The incidence, etiology, impact, and management of anemia in critical care patients and the development of treatment guidelines and protocols for the management of anemia in this patient population are discussed. SUMMARY Most patients in intensive care units develop anemia as a result of blood losses, nutritional deficiencies, hemolysis, myelosuppression, renal insufficiency, inflammation, infection, or another disease process. Anemia can have an adverse impact on critically ill patients with severe ischemic heart disease or cerebrovascular disease and patients undergoing surgery. The use of blood conservation measures and restrictive blood transfusion strategies can circumvent problems associated with transfusion. Epoetin alfa increases hemoglobin concentrations and reduces the need for transfusion in critical care patients, including surgical patients with large anticipated blood losses. Epoetin alfa also appears to be effective for managing anemia in patients with multiple organ dysfunction syndrome. Iron supplementation is needed by most patients receiving erythropoietic therapy. Iron supplementation without erythropoietic therapy is inadequate to correct anemia unrelated to iron deficiency. Concerns have been raised about a possible increased risk for infection when parenteral iron therapy is used in critical care patients. Developing treatment guidelines or protocols for managing anemia in critical care patients can minimize the need for transfusions and improve prescribing of erythropoietic therapy. CONCLUSION Epoetin alfa can play an important role in managing anemia in critical care patients, thereby minimizing patient exposure to transfusion-related risks and optimizing the use of the limited blood supply. There is currently no data available for use of darbepoetin in this manner.