Pre-operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery

Muñoz, M.; Laso-Morales, MaríaJesús; Gómez‐Ramírez, Susana; Cadellas, M.; Núñez‐Matas, María José; García-Erce, José Antonio

doi:10.1111/anae.13840

Cited by 174 publications

(146 citation statements)

References 39 publications

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“…In a large cohort of major elective procedures ( n = 3,342), overall prevalence of anemia (Hb <13 g/dL) was 36%, with differences between genders (53% in women, 23% in men; p < 0.001) and procedures (gynecologic surgery, 64%; colorectal cancer, 58%; cardiac surgery, 40%; liver metastasis resection, 37%; elective orthopedic surgery, 26%; and radical prostatectomy, 8%) [7]. Over 70% of anemic patients presented with ID or functional ID (FID), resulting in iron-restricted erythropoiesis (IRE) [7].…”

Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

“…Over 70% of anemic patients presented with ID or functional ID (FID), resulting in iron-restricted erythropoiesis (IRE) [7]. As for nonelective procedures, up to 75% of patients undergoing hip fracture repair surgery ( n = 1,004) presented with Hb <13 g/dL on admission [8].…”

Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

“…The emerging evidence that nonanemic ID is a disease in its own right that deserves attention because of the risk it poses for patients including the surgical population. In the above-mentioned study [7], 42% of nonanemic patients presented with ID or FID and 27% with low iron stores (as defined by preoperative ferritin <100 ng/mL) [7]. Vitamin B 12 deficiency (defined as serum concentration <270 pg/mL) or folate deficiency (defined as serum concentration <3 ng/mL) are less frequent (≈10%), but they should also be repleted in cases of deficiency [7].…”

Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

“…In the above-mentioned study [7], 42% of nonanemic patients presented with ID or FID and 27% with low iron stores (as defined by preoperative ferritin <100 ng/mL) [7]. Vitamin B 12 deficiency (defined as serum concentration <270 pg/mL) or folate deficiency (defined as serum concentration <3 ng/mL) are less frequent (≈10%), but they should also be repleted in cases of deficiency [7]. These deficiencies may hamper preoperative Hb optimization and/or the recovery from postoperative anemia as well as increase postoperative morbidity.…”

Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

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Management of Perioperative Iron Deficiency Anemia

et al. 2019

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Preoperative anemia affects 30–40% of patients undergoing major surgery and is an independent risk factor for perioperative blood transfusion, morbidity, and mortality. Absolute or functional iron deficiency is its leading cause. Nonanemic hematinic deficiencies are also prevalent and may hamper preoperative hemoglobin optimization and/or recovery from postoperative anemia. As modifiable risk factors, anemia and hematinic deficiencies should be detected and corrected prior to major surgical procedures. Postoperative anemia is even more common (up to 80–90%) due to surgery-associated blood loss, inflammation-induced blunted erythropoiesis, and/or preexisting anemia. Preoperative oral iron may have a role in mild-to-moderate anemia, provided there is sufficient time (6–8 weeks) and adequate tolerance of oral preparations. Postoperative oral iron is of little value and rife with gastrointestinal adverse events. Intravenous iron should preferentially be used in cases of moderate-to-severe iron deficiency anemia, concomitant use of erythropoiesis-stimulating agents, short time to surgery or nonelective procedures, and for postoperative anemia management. Minor infusion reactions to intravenous iron are rare, the incidence of severe anaphylactic reactions is extremely low, and there is no increase in infections with intravenous iron. Currently available intravenous iron formulations allowing administration of large single doses are preferred.

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Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

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Management of Perioperative Iron Deficiency Anemia

et al. 2019

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“…Adopting a threshold of 130 g/L, Jans et al report an anaemia prevalence of 31% of patients undergoing primary TKA in Denmark,12 and the same prevalence has been reported in Spain 13. Anaemia is more prevalent in patients undergoing revision surgery in association with increasing age and comorbidities.…”

Section: Preoperativementioning

confidence: 99%

Blood management in total knee arthroplasty: state-of-the-art review

et al. 2018

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Total blood loss from primary total knee arthroplasty may exceed 2 L with greater blood loss during revision procedures. Blood loss and allogeneic transfusion are strongly associated with adverse outcomes from surgery including postoperative mortality, thromboembolic events and infection. Strategies to reduce blood loss and transfusion rates improve patient outcomes and reduce healthcare costs. Interventions are employed preoperatively, intraoperatively and postoperatively. The strongest predictor for allogeneic blood transfusion is preoperative anaemia. Over 35% of patients are anaemic when scheduled for primary and revision knee arthroplasty, defined as haemoglobin <130 g/L for men and women, and the majority of cases are secondary to iron deficiency. Early identification and treatment of anaemia can reduce postoperative transfusions and complications. Anticoagulation must be carefully managed perioperatively to balance the risk of thromboembolic event versus the risk of haemorrhage. Intraoperatively, tranexamic acid reduces blood loss and is recommended for all knee arthroplasty surgery; however, the optimal route, dose or timing of administration remains uncertain. Cell salvage is a valuable adjunct to surgery with significant expected blood loss, such as revision knee arthroplasty. Autologous blood donation is not recommended in routine care, sealants may be beneficial in select cases but further evidence of benefit is required, and the use of a tourniquet remains at the discretion of the surgeon. Postoperatively, restrictive transfusion protocols should be followed with a transfusion threshold haemoglobin of 70 g/L, except in the presence of acute coronary syndrome. Recent studies report no allogeneic transfusions after primary knee arthroplasty surgery after employing blood conservation strategies. The current challenge is to select and integrate different blood conserving interventions to deliver an optimal patient pathway with a multidisciplinary approach.

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