Impact of Preoperative Iron Deficiency on Blood Transfusion in Elective Cardiac Surgery

Abstract

words)Objective: To evaluate the incidence and consequences of preoperative iron deficiency in elective cardiac surgery.Design: A prospective observational study. Setting:The cardiac surgery unit of a university hospital, from November 2016 to February 2017.Participants: All patients presenting for elective cardiac surgery during the study period, with the exclusion of non-cardiac thoracic surgeries, surgeries of the descending aorta, endovascular procedures, and patients affected by an iron-metabolism disease.Intervention: Transferrin saturation and serum ferritin levels were systematically assessed before surgery and the care of patients maintained as usual. Measurements and Main Results:Routine analyses, clinical data, and the number of blood transfusions were recorded during the hospital stay. Among the 272 patients included, 31% had preoperative iron deficiency, and 13% were anemic. Patients with iron deficiency had significantly lower hemoglobin levels throughout the hospital stay and received blood transfusions more frequently during surgical procedures (31% vs. 19%, p = 0.0361). Detailed analysis showed that patients with iron deficiency received more red blood cell units. There were no differences in postoperative bleeding, morbidity, or mortality. Conclusions:Iron deficiency appears to be related to lower hemoglobin levels and more frequent transfusion in elective cardiac surgery. Assessing iron status preoperatively and correcting any iron deficiencies should be one of the numerous actions involved in patient blood management for such surgeries, with the aim of reducing morbidity due to both anemia and transfusion. * Mean +/-standard deviation • Number of patients (percentage) Redux: first reoperation after one cardiac surgery. Tridux: second reoperation. CPB: cardiopulmonary bypass.

Iron Correction During Bloodless Surgery in Patients With Mitral Heart Diseases

“…Ряд авторов указывают на исходно низкий уровень Hb и исходно низкий уровень железа в сыворотке крови у пациентов как на одну из причин анемии [10,11]. Некоторые авторы [12] указывают на исходный дефицит железа 31% и анемию 13% у больных с сердечно-сосудистыми заболеваниями. Автор приходит к заключению: чем ниже гемоглобин, тем чаще переливание донорской крови, а коррекция железа уменьшает процент переливания крови с 31% до 19%.…”

Impact of Preoperative Iron Deficiency on Blood Transfusion in Elective Cardiac Surgery—Reply to N. Mayeur et al.

“…We thank Mayeur et al for their interesting comment on our article, 1 and we would like to respond to their concerns.…”

“…We read with great interest the recent article entitled "Impact of Preoperative Iron Deficiency on Blood Transfusion in Elective Cardiac Surgery" published in the Journal of Cardiothoracic and Vascular Anesthesia. 1 This prospective observational study aims at assessing the incidence of preoperative iron deficiency (ID) and ID anemia in patients undergoing elective cardiac surgery. As commonly accepted, ID was defined in this study by a serum ferritin level <100 ng/mL or <300 ng/mL in association with transferrin saturation <20%.…”

Anemia of Inflammation with An Emphasis on Chronic Kidney Disease

“…It is characterized by decreased exercise capacity (reduced exercise capacity of 5,6 and worse) by the New York Heart Association (NYHA) functional classification. There are different causes of anemia in HF, arising from the heterogeneous manifestations of the disorder [25]. Anemia caused by absolute iron deficiency in HF may be due to nutritional factors, such as low dietary iron, poor appetite loss, decreased iron absorption due to gastrointestinal blood loss caused by gut inflammation and consequences of iatrogenic agents [26].…”