Current concepts in the evaluation and management of preoperative anemia

Neef, Vanessa; Choorapoikayil, Suma; Piekarski, Florian; Schlesinger, Tobias; Meybohm, Patrick; Zacharowski, Kai

doi:10.1097/aco.0000000000000979

Cited by 13 publications

(16 citation statements)

References 35 publications

(37 reference statements)

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“…Efforts to identify preoperative anemia tend to focus on patients having higher risk surgeries [32]. For example, it has been recently suggested that laboratory testing only be performed in those with estimated blood loss of >500mL [33].…”

Section: Discussionmentioning

confidence: 99%

Estimating the prevalence of anemia and its association with perioperative blood transfusion in patients who have no haemoglobin measurement using multiple imputation and inverse probability of treatment weighting

Miller¹,

Delroy-Buelles²,

Congreve³

et al. 2022

Preprint

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Anemic patients are at increased risk of intraoperative and postoperative transfusion, infection and mortality. Anemia is common in surgical patients, previous studies report a prevalence of 30-40%. While patient blood management programs advise screening for anemia, other perioperative initiatives advocate limiting preoperative laboratory testing. Therefore, a large number of surgical patients may not be screened, missing the opportunity for further investigation and management. In our single-center retrospective cohort study of all adult surgical patients over one year, we sought to estimate the proportion of anemia in patients without a preoperative blood test and their associated intraoperative and postoperative transfusion risk using multiple imputation to estimate missing hemoglobin values and inverse-probability-of-treatment-weighting to balance the study groups. Multiple imputation generated 39 datasets containing plausible hemoglobin values for patients missing a hemoglobin. Patients were classified as known-anemic, known-not-anemic, imputed-anemic and imputed-not-anemic if the hemoglobin was measured or imputed. We then compared red-cell transfusion yes/no by logistic regression, and number of red-cell units transfused by linear regression, pooling the results. Thirty-nine percent of 7879 patients were missing a hemoglobin, of whom 20-35% may be anemic. Only known-anemic patients had an increased intraoperative transfusion risk (odds ratio (OR) 3.13, 95% confidence interval (95%CI) 2.19 to 4.48). Both known-anemic and imputed-anemic patients had increased postoperative transfusion risk (OR 3.93 (95%CI 2.92 to 5.29), OR 2.99 (95%CI 1.61 to 5.56), respectively). Anemia may be common in patients missing a haemoglobin, and may confer an increased risk of postoperative transfusion compared to known-anemic patients. Removing them from observation studies on anemia risks sample bias. Excluding patients from pre-operative testing may miss the opportunity to identify anemia and modify postoperative transfusion risk and other adverse health outcomes. Future research could use point-of-care tests to reduce screening costs, and further investigate adverse outcomes risks in these missing patients.

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Section: Discussionmentioning

confidence: 99%

Estimating the prevalence of anemia and its association with perioperative blood transfusion in patients who have no haemoglobin measurement using multiple imputation and inverse probability of treatment weighting

Miller¹,

Delroy-Buelles²,

Congreve³

et al. 2022

Preprint

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show abstract

“…For diagnosing ISA, Munoz et al [19], in their international consensus statement on the perioperative management of anaemia and iron deficiency, suggest cut-off values for serum ferritin of less than 100 mg/l and TSAT less than 20% for diagnosing IDA. However, these cut-offs may differ based on comorbidities, particularly chronic kidney disease or chronic heart failure [19,21,23]. A serum ferritin level less than 30 mg/l is the most sensitive (92%) and specific (98%) cut-off for identifying true IDA [19].…”

Section: Diagnosismentioning

confidence: 99%

“…Delineation of the cause of anaemia is essential to guide proper treatment. The incidence of varied causes is approximately: nutritional deficiency anaemia, including iron (the primary cause in this category), folate and vitamin B12 (approximately one-third), anaemia of chronic disease, including chronic inflammatory conditions, and renal insufficiency (approximately one-third), and unexplained anaemia, including myelodysplasia and malignancy (approximately one-third) [21,22].…”

Section: Treatmentmentioning

confidence: 99%

Current concepts in evaluation and management of preoperative anaemia in patients undergoing thoracic surgery

Lanigan

Wilkey²

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe purpose of this review is to evaluate the current recommendations for management of perioperative anaemia in patients undergoing thoracic surgery, present the impact of anaemia on outcomes in this patient population and suggest an algorithm for evaluating and treating anaemia preoperatively. Recent findingsAnaemia is a common medical issue noted preoperatively in patients presenting for thoracic surgery and carries significant morbidity. Preoperative anaemia increases the likelihood of receiving a perioperative transfusion, which represents a significant risk factor for morbidity and reduced disease-free survival in lung cancer patients presenting for thoracic surgery. It is also associated with longer hospital lengths of stay and increased risk for reoperation following lung transplantation. An algorithm-based approach to management of anaemia is beneficial and treatment with iron has been shown to reduce transfusions. SummaryPatients undergoing thoracic surgery have a high incidence of preoperative anaemia that increases the risk of transfusion and postoperative morbidity. Preoperative evaluation and tailored treatment based on the underlying cause of anaemia reduces the incidence of anaemia prior to surgery and decreases transfusion rates.

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“…[13][14][15] Perioperative allogenic blood transfusions have, themselves, been associated with postoperative morbidity. 17 In particular, older patients, those with comorbidities, and patients requiring urgent or emergent surgery are at increased risk after transfusion. 18 With the aim of reducing postoperative transfusions, the 2017 European Association for Cardio-Thoracic Surgery and European Association of Cardiothoracic Anaesthesiology guidelines regarding blood management for adult cardiac surgery patients recommend preoperative treatment with erythropoietin (Epo), with or without iron.…”

Section: Manage Anemia and Blood Transfusionmentioning

confidence: 99%

“…13–15 Perioperative allogenic blood transfusions have, themselves, been associated with postoperative morbidity. 17 In particular, older patients, those with comorbidities, and patients requiring urgent or emergent surgery are at increased risk after transfusion. 18…”

Section: Manage Anemia and Blood Transfusionmentioning

confidence: 99%