Stimulating erythropoiesis before hip fracture repair for reducing blood transfusion: should we change the hemoglobin cutoff level for defining anemia in females?

Múñoz, Manuel; Gómez‐Ramírez, Susana; Auerbach, Michael

doi:10.1111/trf.13750

Cited by 9 publications

(7 citation statements)

References 28 publications

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“…12 Females have lower circulating blood volumes and reduced red cell mass compared with males, but experience similar blood loss within same surgery, reaching transfusion threshold faster and therefore resulting in higher transfusion rates. 35,36 Future studies should carefully consider to adjust the threshold for anemia in female patients. In addition, it would be interesting to further elucidate the impact of different treatment periods in a larger number of patients.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Preoperative Iron Supplementation in Major Surgical Patients With Iron Deficiency

et al. 2019

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Objective: To evaluate the effectiveness of routine intravenous iron in surgical patients with iron deficiency anemia (IDA). Background: Anemia is the most common medical disease in the world and is an independent risk factor for morbidity and mortality. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on surgical outcome. Methods: In this prospective single-center observational study, surgical patients were screened for the presence of anemia and ID. Patients were assigned to 1 of 4 study groups:anemia, iron-deficient, iron supplementation) according to hemoglobin level, iron status, and supplementation with iron. Results: Among 1728 patients, 1028 were assigned to A), a reduced intraoperative transfusion rate was observed for ID and IDA patients only if iron was supplemented >7 days before surgery. Hospital stay was significantly reduced by 2.8 days in ironsupplemented patients (P < 0.01 comparing 13.9 AE 0.8 days for A þ , ID þ , T þ vs. 16.7 AE 0.7 days for A þ ). Conclusion: Preoperative IDA management with intravenous iron is effective in improving hemoglobin level, thereby reducing intraoperative RBC transfusion rate particular if iron is administrated >7 days before surgery. Hospital length of stay was reduced in all preoperatively iron-supplemented IDA patients.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Preoperative Iron Supplementation in Major Surgical Patients With Iron Deficiency

et al. 2019

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“…Thirdly, in Europe (but not in the UK), recombinant human erythropoietin administration is approved for reducing transfusion rates in patients with haemoglobin levels between 100 and 130 g.l −1 and adequate iron stores, who are scheduled for elective orthopaedic surgery, and expected to have moderate blood loss, irrespective of sex . In a large series of hip fracture repair surgery (n = 1443), a significant reduction in transfusion rates was observed for those patients (n = 305) presenting with haemoglobin concentrations between 120 g.l −1 and 130 g.l −1 , and who received peri‐operative intravenous iron sucrose (400–600 mg), with or without recombinant human erythropoietin (40.000 IU) .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Pre-operative anaemia in patients undergoing major surgical procedures has been linked to poor outcomes. Therefore, early detection and treatment of pre-operative anaemia is recommended. However, to effectively implement a pre-operative anaemia management protocol, an estimation of its prevalence and main causes is needed. We analysed data from 3342 patients (44.5% female) scheduled for either: elective orthopaedic surgery (n = 1286); cardiac surgery (n = 691); colorectal cancer resection (n = 735); radical prostatectomy (n = 362); gynaecological surgery (n = 203) or resection of liver metastases (n = 122). For both sexes, anaemia was defined by a haemoglobin level < 130 g.l ; absolute iron deficiency by ferritin < 30 ng.ml (< 100 ng.ml , if transferrin saturation < 20% or C-reactive protein > 5 mg.l ); iron sequestration by transferrin saturation < 20% and ferritin > 100 ng.ml ; and low iron stores by transferrin saturation > 20% and ferritin 30-100 ng.ml . The overall prevalence of anaemia was 36%, with differences according to the type of surgery. Laboratory parameters allowing classification of iron status were available for 2884 patients. Among those with anaemia (n = 986), 677 (69%) were women, 608 (62%) presented with absolute iron deficiency, 101 (10%) with iron sequestration; and 150 (5%) with low iron stores. Iron status alterations were similar in women with haemoglobin < 130 g.l or < 120 g.l . For those who were not anaemic (n = 1898), corresponding figures were 656 (35%), 621 (33%), 165 (9%) and 518 (27%), respectively. Anaemia was present in one-third of patients undergoing major elective procedures. Over two-thirds of anaemic patients presented with absolute iron deficiency or iron sequestration. Over half of non-anaemic patients presented with absolute iron deficiency or low iron stores. We consider these data useful for planning pre-operative management of patients scheduled for major elective surgery.

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“…Thus, the authors may have included patients who most probably will not benefit from treatment while excluded others who may benefit from it. In fact, previously published transfusion data from patients with hip fracture receiving intravenous iron, with or without EPO, were stratified according to admission Hb (9–13 g/dl; n = 582) . Data analysis showed that for Hb 9–12 g/dl, there were no differences in ABT rates regardless treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Data analysis showed that for Hb 9–12 g/dl, there were no differences in ABT rates regardless treatment. However, for those presenting with Hb between 12 and 13 g/dl, which represent one‐third of study sample, treatment with intravenous iron, with or without EPO, led to a significant reduction of ABT rate compared to standard care (oral iron or no iron) . On the other hand, their transfusion protocol dictates that patients with Hb <7 g/dl will receive 3 RBC units, independently of symptoms, and those with Hb 7·1–8·9 g/dl and severe symptoms will receive 2 RBC units .…”

Section: Discussionmentioning

confidence: 99%

Short‐term perioperative iron in major orthopedic surgery: state of the art

Gómez‐Ramírez

Maldonado-Ruiz²,

Campos-Garrigues

et al. 2018

Vox Sanguinis

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In major orthopaedic surgery, it is recommended to detect and correct preoperative anaemia several weeks prior to surgery. However, in many cases, the procedure is urgent or the patient is evaluated shortly before the intervention. As iron deficiency is the leading cause of perioperative anaemia, an exhaustive review of the literature was performed to assess the efficacy and safety of short‐term perioperative intravenous, with or without erythropoietin, or postoperative oral or intravenous supplementation in major orthopaedic surgery. Overall, 20 studies met the inclusion criteria. There were 13 randomized trials (moderate quality) and seven observational studies (low to very low quality). The primary outcomes were reduction in transfusion requirements, haemoglobin increase and medication side‐effects during the study period. Data analysis showed that postoperative oral iron administration neither increased haemoglobin nor reduced transfusion requirements, and it was associated with significant gastrointestinal adverse effects (15%). In contrast, for some patient populations, perioperative or postoperative administration of intravenous iron, with or without recombinant erythropoietin, may reduce transfusion requirements and/or hasten the recovery from postoperative, with few clinically relevant adverse effects (<2%). However, discrepancies between randomized trials and observational studies on the possible beneficial effects of short‐term perioperative intravenous iron administration were found for patients undergoing surgery for hip fracture repair. Further studies are needed to elucidate when the treatment should be started, which combination of drugs should be used, and which patient groups would be most benefit.

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Stimulating erythropoiesis before hip fracture repair for reducing blood transfusion: should we change the hemoglobin cutoff level for defining anemia in females?

Cited by 9 publications

References 28 publications

Effectiveness of Preoperative Iron Supplementation in Major Surgical Patients With Iron Deficiency

Effectiveness of Preoperative Iron Supplementation in Major Surgical Patients With Iron Deficiency

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

Short‐term perioperative iron in major orthopedic surgery: state of the art

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