Implementation of an anaemia walk‐in clinic: Feasibility and preliminary data from the Orthopedic University Hospital

Abstract

Background: Approximately one in three patients suffers from preoperative anaemia. Even though haemoglobin is measured before surgery, anaemia management is not implemented in every hospital. Objective: Here, we demonstrate the implementation of an anaemia walk-in clinic at an Orthopedic University Hospital. To improve the diagnosis of iron deficiency (ID), we examined whether reticulocyte haemoglobin (Ret-He) could be a useful additional parameter. Material and Methods: In August 2019, an anaemia walk-in clinic was established. Between September and December 2019, major orthopaedic surgical patients were screened for preoperative anaemia. The primary endpoint was the incidence of preoperative anaemia. Secondary endpoints included Ret-He level, red blood cell (RBC) transfusion rate, in-hospital length of stay and anaemia at hospital discharge. Results: A total of 104 patients were screened for anaemia. Preoperative anaemia rate was 20.6%. Intravenous iron was supplemented in 23 patients. Transfusion of RBC units per patient (1.7 ± 1.2 vs. 0.2 ± 0.9; p = 0.004) and hospital length of stay (13.1 ± 4.8 days vs. 10.6 ± 5.1 days; p = 0.068) was increased in anaemic patients compared to nonanaemic patients. Ret-He values were significantly lower in patients with ID anaemia (33.3 pg [28.6-40.2 pg]) compared to patients with ID (35.3 pg [28.9-38.6 pg]; p = 0.015) or patients without anaemia (35.4 pg [30.2-39.4 pg]; p = 0.001). Conclusion: Preoperative anaemia is common in orthopaedic patients. Our results proved the feasibility of an anaemia walk-in clinic to manage preoperative anaemia. Furthermore, our analysis supports the use of Ret-He as an additional parameter for the diagnosis of ID in surgical patients. K E Y W O R D S anaemia walk-in clinic, blood transfusion, iron deficiency, orthopaedic patients, patient blood management, reticulocyte haemoglobin Patrick Meybohm and Andrea Meurer contributed equally to this study.

Reticulocyte and Erythrocyte Hemoglobin Parameters for Iron Deficiency and Anemia Diagnostics in Patient Blood Management. A Narrative Review

“…More recently, preoperative anemia walk-in clinics have been established at several hospitals in Germany. In one of them, use of RET-H e was tested and eventually adopted as a routine parameter to screen for anemia before orthopedic surgery [ 62 ]. Including a score to detect infection generated from the same hematology analyzers in such protocols may, in the end, also resolve concerns about iron therapy in cases where severe infection may be suspected.…”

2020: A year we will remember

“…Turning to transfusion for haemoglobinopathy patients, perhaps the clinical group with the most complex red cell requirements, we publish a retrospective review of transfusion in a large London cohort of haemoglobinopathy patients by Sara Trompeter and colleagues 7 . Several papers highlight different aspects of patient blood management, including an article by Vanessa Neef and colleagues from Frankfurt, describing the impact of a walk‐in clinic for anaemia for elective orthopaedic surgery patients 8 . Looking further afield, Giulia Reggiani and Arlindo Muhelo from Beira in Mozambique look at transfusion thresholds in paediatric trauma patients and suggest that using transfusion thresholds may spare blood and improve care.…”