Iron Deficiency Anemia—Bridging the Knowledge and Practice Gap

Shander, Aryeh; Goodnough, Lawrence T.; Javidroozi, Mazyar; Auerbach, Michael; Carson, Jeffrey L.; Ershler, William B.; Ghiglione, Mary; Glaspy, John A.; Lew, Indu

doi:10.1016/j.tmrv.2014.05.001

Cited by 97 publications

(76 citation statements)

References 187 publications

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“…Population studies in the UK have shown anaemia to be more prevalent than diabetes, with a similar incidence to cardiovascular disease [10]. The prevalence of anaemia in over a hundred studies in differing medical populations has recently been reviewed [12]. In pre-operative patients, one third will be found to be anaemic at pre-assessment.…”

Section: Prevalence Of Anaemiamentioning

confidence: 99%

Pre‐operative anaemia

2014

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SummaryPre‐operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri‐operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non‐cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre‐operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of ‘functional’ iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre‐operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

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Section: Prevalence Of Anaemiamentioning

confidence: 99%

Pre‐operative anaemia

2014

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“…For example, a large review of 31,857 patients undergoing elective vascular surgery identified 47% as having preoperative anemia [32]. The prevalence of anemia in hospitalized patients ranges from that in the general population to much higher, depending on the reason for admission, co-morbidities and patient factors such as age and gender; the reported prevalence is at least 25-50% and may be higher, with the elderly and those with chronic conditions at increased risk [33,34]. Also, 74% of hospitalized patients will develop a hospitalacquired anemia [35] with 95% of patients admitted to the intensive care unit (ICU) developing anemia by the third ICU day [36].…”

Section: Preoperative Anemia Evaluation and Readiness For Surgerymentioning

confidence: 99%

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

Freedman¹

2016

J Perioper Crit Intensive Care Nurs

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Despite increasing recognition of the potential adverse effects of blood transfusion there is evidence that the procedure is over-utilized and often inappropriately and unnecessarily administered. Patient Blood Management (PBM) is a recent world-wide initiative to optimize transfusion therapy by employing preoperative and perioperative maneuvers and alternatives to avoid unnecessary blood transfusion. These approaches are, however, not restricted to the surgical setting, but may be applied whenever transfusion is contemplated. A key component of PBM is the appropriate management of anemia, a prime determinant of transfusion. Another is tolerance of anemia through the use of restrictive transfusion thresholds for transfusion and of a single unit at a time policy. Among a number of options at surgery, antifibrinolytics have proven effective at reducing blood loss and transfusion. Burgeoning literature demonstrates that PBM (also known as Blood Conservation or as 'Bloodless Medicine/Surgery') is costeffective while improving patient outcomes and conserving the blood supply. Data from the ONTraC program in Ontario are described herein to illustrate the effectiveness of PBM approaches.

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“…Acute causes of iron deficiency in the inpatient or postoperative setting may be blood loss related to the acute illness (eg, gastrointestinal or other sources) or iatrogenic due to surgeries, procedures, and recurrent phlebotomy. 33 Iron insufficiency has been implicated in the pathogenesis of RLS. 34 RLS is present in more than 20% of patients with iron deficiency anemia, 35 and low serum ferritin levels are associated with more severe symptoms in patients with RLS.…”

Section: Anemiamentioning

confidence: 99%

“…However, reducing iatrogenic causes of anemia in the hospital such as excessive phlebotomy is crucial. 33 Patients with RLS symptoms and insufficient iron stores reflected by ferritin level less than 75 mg/mL may benefit from iron supplementation. 57,75,76 However, because ferritin is an acutephase reactant, it may not reflect inadequate iron levels, particularly in an inpatient setting.…”

Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

Management of Restless Legs Syndrome/Willis-Ekbom Disease in Hospitalized and Perioperative Patients

Goldstein

2015

Sleep Medicine Clinics

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Iron Deficiency Anemia—Bridging the Knowledge and Practice Gap

Cited by 97 publications

References 187 publications

Pre‐operative anaemia

Pre‐operative anaemia

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

Management of Restless Legs Syndrome/Willis-Ekbom Disease in Hospitalized and Perioperative Patients

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