Assessment and treatment of preoperative anemia: Continuing Professional Development

Hare, Gregory M. T.; Baker, James E.; Pavenski, Katerina

doi:10.1007/s12630-011-9498-2

Cited by 22 publications

(17 citation statements)

References 63 publications

(146 reference statements)

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“…Some studies have shown that perioperative anemia increases the rate of postoperative complications [4,5], whereas others have shown that mild anemia does not affect the rate of postoperative complications [8].…”

Section: Discussionmentioning

confidence: 99%

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Impact of perioperative hemoglobin levels on postoperative outcomes in gastric cancer surgery

et al. 2012

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Background The aim of this study was to evaluate the association of postoperative blood transfusion and anemia with postoperative outcomes in gastric cancer surgery. Methods We enrolled 588 patients who had undergone curative resection for gastric cancer. Input variables for risk assessment consisted of 3 categories: patient demographics, surgical and pathological factors, and anemia-related factors. Postoperative outcomes included 30-day morbidity and mortality. Univariate and multivariate analyses were performed to identify risk factors influencing postoperative complications. Results The rate of total complications was 19.0 %. Comorbidity, lowest hemoglobin (Hb) level from the operative day up to postoperative day 7 (LOW-Hb), the percentage of drop in Hb level on postoperative day 2 (POD2-Hb change), and postoperative transfusion were independent risk factors in the multivariate analysis, with LOW-Hb and postoperative transfusion found to be the most significant factors. When LOW-Hb was C9.0 g/dL, postoperative complications were higher in the transfused group than in the non-transfused group (60.0 vs. 14.2 %, respectively, p = 0.024), but when LOW-Hb was\9.0 g/dL, postoperative complications were not different between the 2 groups (44.6 vs. 37.5 %, p = 0.525). ConclusionThe lowest postoperative Hb level and postoperative transfusion were the most significant risk factors for postoperative complications in gastric cancer surgery.

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Section: Discussionmentioning

confidence: 99%

“…Anemia increases complications during the perioperative period [4,5]. Transfusion is an effective treatment method for anemia [6], and it was thought that transfusion may reduce the rate of anemia-related postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Impact of perioperative hemoglobin levels on postoperative outcomes in gastric cancer surgery

et al. 2012

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“…The prevalence of preoperative anemia is positively correlated with the age of the patient and more often found in elderly patients [2, 5]. Anemia of chronic disease (ACD) and iron deficiency (ID) are the most frequent causes of preoperative anemia [2, 6]. Low preoperative hemoglobin (Hb) levels are well known as major predicting factors in requiring perioperative blood transfusion in orthopedic surgery [7, 8].…”

Section: Introductionmentioning

confidence: 99%

“…It is the more important since treatment differs depending on the principle cause of anemia. So, in patients with ACD, treatment with an erythropoiesis-stimulating agent (ESA) is recommended [2, 6, 10, 11]. To potentate the erythropoietic response in erythropoietin therapy and to avoid functional ID, patients should receive intravenous (i.v.)…”

Section: Introductionmentioning

confidence: 99%

The Impact of an Algorithm-Guided Management of Preoperative Anemia in Perioperative Hemoglobin Level and Transfusion of Major Orthopedic Surgery Patients

Enko

Wallner

von-Goedecke³

et al. 2013

Anemia

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The aim of this study was to evaluate a laboratory-guided therapeutic algorithm of preoperative anemia. 335 patients with elective hip or knee arthroplasty were included in this retrospective before-after study. Group I (n = 101) underwent conventional preoperative procedures before algorithm implementation. Group II (n = 234) underwent algorithm-guided preoperative anemia management. A hemoglobin-level of 13 g/dL was the therapeutic cut-off for men and women. Reticulocyte hemoglobin content (CHr) and soluble transferrin receptor (sTfR)/log ferritin ratio were used in the form of the Thomas plot. Iron deficiency (ID) was substituted with 1000 mg iron intravenous (i.v.) and 10000 international units (I.U.) of erythropoiesis-stimulating agent (ESA) subcutaneous (s.c.) or i.v., anemia of chronic disease (ACD) (without functional ID) with 40000 I.U. ESA s.c. or i.v and additionally 200 mg iron i.v. Substituted anemic patients in Group II (n = 32) showed a distinctly higher preoperative (Hb-median 13 versus 11.95 g/dL) (P < 0.01) and postoperative (Hb-median 9.75 versus 9.0 g/dL) (P < 0.05) Hb level compared with untreated anemic patients in Group I (n = 24). In Group II red blood cell (RBC) units (35 units/234 patients) were reduced by 44% compared with Group I (27 units/101 patients). Algorithm-guided preoperative anemia management raises perioperative Hb-level and reduces blood use.

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“…22 Before the 1980s, many clinicians abided by the '10/30 rule': safe surgery required preoperative Hb >10g/dl (100g/ l) or haematocrit (Hct) >30%. 23 It is generally accepted Hb >100g/l: Do not transfuse ACS = acute coronary syndrome; ARR = absolute risk reduction; CAD = coronary artery disease; CI = confidence interval; CPB = cardiopulmonary bypass; Hb =haemoglobin; Hct = haematocrit; HR = hazard ratio; MI = myocardial infarction; RCT = randomised controlled trial; RR = relative risk; VTE = venous thromboembolism that Hct (%) is roughly three times the Hb value (g/dl). 24 This recommendation was originally intended for high risk anaesthesia patients.…”

Section: Indications For Prbc Transfusions In Patients With Cadmentioning

confidence: 99%

An evidence-based approach to red blood cell transfusions in asymptomatically anaemic patients

Chan

2015

annals

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INTRODUCTION Surgeons and physicians encounter blood transfusions on a daily basis but a robust evidence-based strategy on indications and timing of transfusion in asymptomatic anaemic patients is yet to be determined. For judicious use of blood products, the risks inherent to packed red blood cells, the patient's co-morbidities and haemoglobin (Hb)/haematocrit levels should be considered. This review critiques and summarises the latest available evidence on the indications for transfusions in healthy and cardiac disease patients as well as the timing of transfusions relative to surgery. METHODS An electronic literature search of the MEDLINE ® , Google Scholar™ and Trip databases was conducted for articles published in English between January 2006 and January 2015. Studies discussing timing and indications of transfusion in medical and surgical patients were retrieved. Bibliographies of studies were checked for other pertinent articles that were missed by the initial search. FINDINGS Six level 1 studies (randomised controlled trials or systematic reviews) and six professional society guidelines were included in this review. In healthy patients without cardiac disease, a restrictive transfusion trigger of Hb 70-80g/l is safe and appropriate whereas in cardiac patients, the trigger is Hb 80-100g/l. The literature on timing of transfusions relative to surgery is limited. For the studies available, preoperative transfusions were associated with a decreased incidence of subsequent transfusions and timing of transfusions did not affect the rates of colorectal cancer recurrence.

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Assessment and treatment of preoperative anemia: Continuing Professional Development

Cited by 22 publications

References 63 publications

Impact of perioperative hemoglobin levels on postoperative outcomes in gastric cancer surgery

Impact of perioperative hemoglobin levels on postoperative outcomes in gastric cancer surgery

The Impact of an Algorithm-Guided Management of Preoperative Anemia in Perioperative Hemoglobin Level and Transfusion of Major Orthopedic Surgery Patients

An evidence-based approach to red blood cell transfusions in asymptomatically anaemic patients

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