Review article: Risks of anemia and related management strategies: can perioperative blood management improve patient safety?

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

“…[22][23][24][25][26][27][28][29][30][31][32][33][34] Our data confirm that patients in the Pre-Protocol group with Fig. 3 The impact of protocol implementation in anemic (Hb \ 120 gÁL -1 ) and non-anemic patients (Hb [ 120 gÁL -1 ) is demonstrated.…”

Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study

“…Anemia and RBC transfusion have been observed in multiple previous studies as important risk factors for AKI after cardiac surgery, but the interrelationship between these variables and AKI has not been as extensively reported. 19,20 In a single-centre observational study comprised of 2,113 propensity-score matched pairs of anemic and non-anemic patients who underwent cardiac surgery with CPB and received up to three units of perioperative RBC transfusions, the risk of AKI was increased in direct proportion to the number of transfusions in both groups, but the increase was much more pronounced in anemic patients. 7 In non-anemic patients, the AKI rate increased from 1.7% in non-transfused patients to 3.2% in those who received three units of RBCs (P = 0.1); however, in anemic patients, the rate increased from 1.8% to 6.6% (P \ 0.0001).…”

“…First, anemic patients (both preoperative and intraoperative) have lower hemoglobin concentrations throughout the perioperative period than non-anemic patients, 32 predisposing them to renal hypoxia. 20 Second, many anemic patients have pre-existing subclinical kidney disease that may increase renal tubular oxygen consumption and oxidative stress, [33][34][35] thus increasing their susceptibility to concurrent renal insults. Finally, anemic patients have abnormal iron metabolism [36][37][38] that may affect the clearance of the large amount of iron released when RBCs are hemolyzed, either during storage or soon after transfusion, and this may potentially lead to the presence of free iron and hemoglobin in the circulation.…”

Blood Transfusions Correct Anemia and Improve Tissue Oxygenation in Surgical and Critically ill Patients

“…Although the administration of iron and erythropoiesis-stimulating agent can increase levels of hemoglobin they have been associated with incidence of thrombosis and cancer progression, infection, length of stay, and mortality (2). Allogenic blood transfusions therefore is still the treatment of choice to correct anemia.…”