Transfusion Alternatives in Orthopedic Surgery

Múñoz, Manuel; García‐Erce, José Antonio; Cuenca, Jorge

doi:10.1002/9781444319583.ch41

Cited by 2 publications

(7 citation statements)

References 59 publications

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“…17 IV iron has also been shown to reduce transfusion requirements in other surgical specialities. 18,19…”

Section: Discussionmentioning

confidence: 99%

“…17 IV iron has also been shown to reduce transfusion requirements in other surgical specialities. 18,19 As many MLLA patients present with anaemia and coexistent coronary artery disease (CAD), a liberal policy regarding blood transfusion in the perioperative period may initially seem justified. However, there are conflicting reports regarding the usefulness of blood transfusions in such patients.…”

Section: Discussionmentioning

confidence: 99%

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The adverse impact of pre-operative anaemia on survival following major lower limb amputation

et al. 2022

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Introduction Approximately 5000 major lower-limb amputations (MLLA) for PAD occur per-annum in the UK with clinical outcomes being poor for this high-risk cohort of patients. Existing evidence suggests that anaemic surgical patients have an increased 30-day mortality, but this has not been explored in the context of MLLA. Recent prioritization processes suggested that MLLAs are a target area for research into outcome improvement. This cohort study evaluates the impact of anaemia on the outcome of MLLA to understand if optimization might improve outcomes. Methods All PAD patients undergoing MLLA during 2015–2018 at a tertiary vascular centre were reviewed. Patients were stratified into groups; non-anaemia (>12 g/dL), mild-anaemia (12-10 g/dL) and severe-anaemia (<10 g/dL) by pre-operative haemoglobin (Hb). Primary outcome was overall survival by Kaplan–Meier. Secondary outcomes included length of stay (LOS), post-operative blood-transfusion, surgical-site infection (SSI) and myocardial infarction (MI). Cox-proportional-hazard and receiver-operator characteristics (ROC) analyses were conducted. Results 345 patients were followed up over (mean) 23 months. 105 were non-anaemic, 111 mildly anaemic and 129 severely anaemic. Patients with severe-anaemia had a higher incidence of heart and renal failure ( p = 0.003) than those with non- or mild-anaemia. Overall survival worsened significantly with increasing anaemia ( p = 0.001). LOS was significantly longer in mild-anaemia which is 26 (16–43) days, ( p = 0.006) and severe-anaemia of 28 days (17–40), ( p < 0.001) compared to non-anaemia of 18 (10–30) days. Post-operative blood-transfusion (RBC) was required more frequently in 70.5% of severely anaemic patients ( p < 0.001), compared to mildly anaemic (24.3%) and non-anaemic (7.6%) patients, with those receiving RBCs having a significantly worse survival. There was no difference in MI, SSI or wound dehiscence. Anaemia was significantly associated with mortality; (HR 1.7 (1.04–2.78), p = 0.03). A minimum-Hb of 10.4 g/L (by ROC) was identified as a cutoff Hb for an increased risk of mortality. Conclusion Pre-operative anaemia is associated with worse outcome following MLLA, with increasing severity of anaemia associated with increasing mortality and RBC transfusion being potentially detrimental. More work is required to prospectively evaluate this relationship in this complex and multi-morbid cohort of patients.

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“…17 IV iron has also been shown to reduce transfusion requirements in other surgical specialities. 18,19…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The adverse impact of pre-operative anaemia on survival following major lower limb amputation

et al. 2022

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“… 13 14 IVIT is preferred when rapid, significant correction is necessary as it has higher efficiency and shorter time to improvement. 14 25 26 …”

Section: Methods and Analysismentioning

confidence: 99%

“… 13 In the former, there is a hepcidin-mediated down regulation of intestinal iron absorption and impaired mobilisation of body iron stores. 14 In the latter, there is a mismatch between iron demand and supply as in the setting of acute blood loss. 13 Both of these clinical scenarios play a role in the setting of orthopaedic trauma requiring operative surgical stabilisation.…”

Section: Introductionmentioning

confidence: 99%

“…Functional iron deficiency results from two main pathways—conditions that incite a systemic inflammatory response (ie, surgery, trauma)6 13 and situations of increased erythropoiesis mediated by endogenous or exogenous erythropoietin stimulation 13. In the former, there is a hepcidin-mediated down regulation of intestinal iron absorption and impaired mobilisation of body iron stores 14. In the latter, there is a mismatch between iron demand and supply as in the setting of acute blood loss 13.…”

Section: Introductionmentioning

confidence: 99%

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Role of single-dose intravenous iron therapy for the treatment of anaemia after orthopaedic trauma: protocol for a pilot randomised controlled trial

et al. 2023

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IntroductionOrthopaedic trauma and fracture care commonly cause perioperative anaemia and associated functional iron deficiency due to a systemic inflammatory state. Modern, strict transfusion thresholds leave many patients anaemic; managing this perioperative anaemia is an opportunity to impact outcomes in orthopaedic trauma surgery. The primary outcome of this pilot study is feasibility for a large randomised controlled trial (RCT) to evaluate intravenous iron therapy (IVIT) to improve patient well-being following orthopaedic injury. Measurements will include rate of participant enrolment, screening failure, follow-up, missing data, adverse events and protocol deviation.Methods and analysisThis single-centre, pilot, double-blind RCT investigates the use of IVIT for acute blood loss anaemia in traumatically injured orthopaedic patients. Patients are randomised to receive either a single dose infusion of low-molecular weight iron dextran (1000 mg) or placebo (normal saline) postoperatively during their hospital stay for trauma management. Eligible subjects include adult patients admitted for lower extremity or pelvis operative fracture care with a haemoglobin of 7–11 g/dL within 7 days postoperatively during inpatient care. Exclusion criteria include history of intolerance to intravenous iron supplementation, active haemorrhage requiring ongoing blood product resuscitation, multiple planned procedures, pre-existing haematologic disorders or chronic inflammatory states, iron overload on screening or vulnerable populations. We follow patients for 3 months to measure the effect of iron supplementation on clinical outcomes (resolution of anaemia and functional iron deficiency), patient-reported outcomes (fatigue, physical function, depression and quality of life) and translational measures of immune cell function.Ethics and disseminationThis study has ethics approval (Oregon Health & Science University Institutional Review Board, STUDY00022441). We will disseminate the findings through peer-reviewed publications and conference presentations.Trial registration numberNCT05292001; ClinicalTrials.gov.

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Transfusion Alternatives in Orthopedic Surgery

Cited by 2 publications

References 59 publications

The adverse impact of pre-operative anaemia on survival following major lower limb amputation

The adverse impact of pre-operative anaemia on survival following major lower limb amputation

Role of single-dose intravenous iron therapy for the treatment of anaemia after orthopaedic trauma: protocol for a pilot randomised controlled trial

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