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Tiglis M, Cobilinschi C, Elena Mirea L, Emil Băetu A, Peride I, Paul Neagu T, Niculae A, Alexandru Checherită I, Marina Grintescu I. The Importance of Iron Administration in Correcting Anaemia After Major Surgery. J Crit Care Med (Targu Mures) 2021; 7:184-191. [PMID: 34722921 PMCID: PMC8519388 DOI: 10.2478/jccm-2021-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Postoperative anaemia can affect more than 90% of patients undergoing major surgeries. Patients develop an absolute iron deficiency in the face of significant blood loss or preoperative anaemia and major surgery. Studies have shown the negative impact of these factors on transfusion requirements, infections, increased hospitalisation and long-term morbidities. AIM OF THE STUDY The research was performed to determine the correlation between intravenous iron administration in the postoperative period and improved haemoglobin correction trend. MATERIAL AND METHODS A prospective study was conducted to screen and treat iron deficiency in patients undergoing major surgery associated with significant bleeding. For iron deficiency anaemia screening, in the postoperative period, the following bioumoral parameters were assessed: haemoglobin, serum iron, transferrin saturation (TSAT), and ferritin, direct serum total iron-binding capacity (dTIBC), mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH). In addition, serum glucose, fibrinogen, urea, creatinine and lactate values were also collected. RESULTS Twenty-one patients undergoing major surgeries (52,38% were emergency and 47,61% elective interventions) were included in the study. Iron deficiency, as defined by ferritin 100-300 μg/L along with transferrin saturation (TSAT) < 20 %, mean corpuscular volume (MVC) < 92 fL, mean corpuscular haemoglobin (MCH) < 33 g/dL, serum iron < 10 μmol/L and direct serum total iron-binding capacity (dTIBC) > 36 μmol/L, was identified in all cases. To correct the deficit and optimise the haematological status, all patients received intravenous ferric carboxymaltose (500-1000 mg, single dose). Using Quadratic statistical analysis, the trend of haemoglobin correction was found to be a favourable one. CONCLUSION The administration of intravenous ferric carboxymaltose in the postoperative period showed the beneficial effect of this type of intervention on the haemoglobin correction trend in these groups of patients.
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Affiliation(s)
- Mirela Tiglis
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
| | - Cristian Cobilinschi
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
| | - Liliana Elena Mirea
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
| | - Alexandru Emil Băetu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
| | - Ileana Peride
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Andrei Niculae
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Ioana Marina Grintescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
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Neidlein S, Wirth R, Pourhassan M. Iron deficiency, fatigue and muscle strength and function in older hospitalized patients. Eur J Clin Nutr 2021; 75:456-463. [PMID: 32901103 PMCID: PMC7943415 DOI: 10.1038/s41430-020-00742-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/31/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES Iron deficiency is common in older patients. We investigated whether iron deficiency is an independent risk factor for functional impairment, low muscle function, fatigue, and rehabilitation progress in older hospitalized patients. SUBJECTS/METHODS Two hundred twenty-four patients (age range 65-95 years; 67% females) who were consecutively admitted to a geriatric acute care ward participated in this prospective longitudinal observational study. Ferritin, iron, transferrin in serum, and blood hemoglobin were measured and current iron supplementation was recorded. Fatigue and comorbidity were measured using the fatigue severity scale and Charlson Comorbidity Index, respectively. Barthel Index, handgrip strength, and isometric knee extension strength were conducted at the time of hospital admission and before discharge. RESULTS Ninety-one (41%) patients had iron deficiency in which the majority had functional iron deficiency (78/91, 86%). Absolute iron deficiency with and without anemia was diagnosed in 12 (13%) and one patients, respectively. Barthel Index and handgrip and knee extension strength significantly improved during hospitalization in iron deficiency and non-iron deficiency groups. Knee extension strength showed better improvement in iron-deficient patients receiving iron supplementation and iron supplementation during hospital stay was the main predictor for improvement in knee extension strength. Comorbidity, iron deficiency, and changes in handgrip strength were the major independent risk factors for poor improvement in Barthel Index during hospitalization. There were significant associations between patients' fatigue and iron deficiency, comorbidity, and female gender. CONCLUSION Iron deficiency is an independent risk factor for fatigue and poor functional recovery among older hospitalized patients. Iron supplementation seems to be capable of improving functional performance.
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Affiliation(s)
- Sophia Neidlein
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany.
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Tagliafico L, Parodi MN, Odetti P, Nencioni A, Monacelli F. Safety and tolerability of intravenous ferric carboxymaltose in the oldest old patients: a prospective cohort study in a University Italian Geriatrics Department. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Țigliș M, Neagu TP, Niculae A, Lascăr I, Grințescu IM. Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods. MEDICINA-LITHUANIA 2020; 56:medicina56100528. [PMID: 33053625 PMCID: PMC7601561 DOI: 10.3390/medicina56100528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/01/2023]
Abstract
Iron deficiency is a major problem in worldwide populations, being more alarming in surgical patients. In the presence of absolute iron deficiency (depletion of body iron), functional iron deficiency (during intense bone marrow stimulation by endogenous or exogenous factors), or iron sequestration (acute or chronic inflammatory conditions), iron-restricted erythropoiesis can develop. This systemic review was conducted to draw attention to the delicate problem of perioperative anemia, and to provide solutions to optimize the management of anemic surgical patients. Systemic reviews and meta-analyses, clinical studies and trials, case reports and international guidelines were studied, from a database of 50 articles. Bone marrow biopsy, serum ferritin levels, transferrin saturation, the mean corpuscular volume, and mean corpuscular hemoglobin concentration were used in the diagnosis of iron deficiency. There are various intravenous iron formulations, with different pharmacological profiles used for restoring iron. In surgical patients, anemia is an independent risk factor for morbidity and mortality. Therefore, anemia correction should be rapid, with parenteral iron formulations—the oral ones—being inefficient. Various studies showed the safety and efficacy of parenteral iron formulations in correcting hemoglobin levels and decreasing the blood transfusion rate, the overall mortality, the postoperative infections incidence, hospitalization days, and the general costs.
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Affiliation(s)
- Mirela Țigliș
- Department of Anaesthesiology and Intensive Care, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (M.Ț.); (I.M.G.)
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Tiberiu Paul Neagu
- Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania;
- Clinical Department No. 11, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence:
| | - Andrei Niculae
- Department of Nephrology and Dialysis, “St. John” Emergency Clinical Hospital, 042122 Bucharest, Romania;
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ioan Lascăr
- Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania;
- Clinical Department No. 11, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ioana Marina Grințescu
- Department of Anaesthesiology and Intensive Care, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (M.Ț.); (I.M.G.)
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Qi X, Zhang Y, Guo H, Hai Y, Luo Y, Yue T. Mechanism and intervention measures of iron side effects on the intestine. Crit Rev Food Sci Nutr 2019; 60:2113-2125. [PMID: 31232087 DOI: 10.1080/10408398.2019.1630599] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Excess oral iron in the intestinal tract usually produces reactive oxygen species via Fenton and Haber-Weiss reaction, so oxidative stress is triggered. Lipid peroxidation procedurally appears, ferroptosis, apoptosis and necrosis are often induced, subsequently, mitochondrial damage, endoplasmic reticulum dysfunction and even cell death occur. As a result, the intestinal epithelial cells are destroyed, leading to the incompleteness of intestinal mechanical barrier. Simultaneously, iron supplement can change the compositions and metabolic processes of intestinal microbes, and the intestinal inflammatory may be worsened. In principle, the easier dissociation of Fe2+ from oral iron supplements is, the more serious intestinal inflammation will occur. Fortunately, some interventions have been developed to alleviate these side effects. For instance, some antioxidants e.g. VE and ferulic acid have been used to prevent the formation of free radicals or to neutralize the formed free radicals. Furthermore, some new iron supplements with the ability of slow-releasing Fe2+, e.g. ferrous citrate liposome and EDTA iron sodium, have been successfully prepared. In order to recover the intestinal micro-ecological balance, probiotics and prebiotics, bacterial consortium transplantation, and fecal microbiota transplantation have been developed. This study is meaningful for us to develop safer oral iron supplements and to maintain intestinal micro-ecological health.
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Affiliation(s)
- Xiao Qi
- College of Food Science and Technology, Northwest University, Xi'an, Shaanxi, China.,School of Chemical Engineering, Northwest University, Xi'an, Shaanxi, China
| | - Yuanxiao Zhang
- School of Chemical Engineering, Northwest University, Xi'an, Shaanxi, China
| | - Hang Guo
- School of Chemical Engineering, Northwest University, Xi'an, Shaanxi, China
| | - Yu Hai
- College of Food Science and Technology, Northwest University, Xi'an, Shaanxi, China
| | - Yane Luo
- College of Food Science and Technology, Northwest University, Xi'an, Shaanxi, China
| | - Tianli Yue
- College of Food Science and Technology, Northwest University, Xi'an, Shaanxi, China.,Ministry of Agriculture, Laboratory of Quality and Safety Risk Assessment for Agro-products (Yangling), Beijing, China
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Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study. PLoS One 2019; 14:e0218152. [PMID: 31194798 PMCID: PMC6564537 DOI: 10.1371/journal.pone.0218152] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background Delirium is a common and serious complication in elderly patients undergoing major abdominal surgery, with significant adverse outcomes. Successful strategies or therapies to reduce the incidence of delirium are scarce. The objective of this study was to assess the role of prehabilitation in reducing the incidence of delirium in elderly patients. Methods A single-center uncontrolled before-and-after study was conducted, including patients aged 70 years or older who underwent elective abdominal surgery for colorectal carcinoma or an abdominal aortic aneurysm between January 2013 and October 2015 (control group) and between November 2015 and June 2018 (prehabilitation group). The prehabilitation group received interventions to improve patients’ physical health, nutritional status, factors of frailty and preoperative anaemia prior to surgery. The primary outcome was incidence of delirium, diagnosed with the DSM-V criteria or the confusion assessment method. Secondary outcomes were additional complications, length of stay, unplanned ICU admission, length of ICU stay, readmission rate, institutionalization, and in-hospital or 30-day mortality. Result A total of 360 control patients and 267 prehabilitation patients were included in the final analysis. The mean number of prehabilitation days was 39 days. The prehabilitation group had a higher burden of comorbidities and was more physically and visually impaired at baseline. At adjusted logistic regression analysis, delirium incidence was reduced significantly from 11.7 to 8.2% (OR 0.56; 95% CI 0.32–0.98; P = 0.043). No statistically significant effects were seen on secondary outcomes. Conclusion Current prehabilitation program is feasible and safe, and can reduce delirium incidence in elderly patients undergoing elective major abdominal surgery. This program merits further evaluation. Trial registration Dutch Trial Registration, NTR5932.
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Abdullah HR, Ang AL, Froessler B, Hofmann A, Jang JH, Kim YW, Lasocki S, Lee JJ, Lee SY, Lim KKC, Singh G, Spahn DR, Um TH. Getting patient blood management Pillar 1 right in the Asia-Pacific: a call for action. Singapore Med J 2019; 61:287-296. [PMID: 31044255 DOI: 10.11622/smedj.2019037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Preoperative anaemia is common in the Asia-Pacific. Iron deficiency anaemia (IDA) is a risk factor that can be addressed under patient blood management (PBM) Pillar 1, leading to reduced morbidity and mortality. We examined PBM implementation under four different healthcare systems, identified challenges and proposed several measures: (a) Test for anaemia once patients are scheduled for surgery. (b) Inform patients about risks of preoperative anaemia and benefits of treatment. (c) Treat IDA and replenish iron stores before surgery, using intravenous iron when oral treatment is ineffective, not tolerated or when rapid iron replenishment is needed; transfusion should not be the default management. (d) Harness support from multiple medical disciplines and relevant bodies to promote PBM implementation. (e) Demonstrate better outcomes and cost savings from reduced mortality and morbidity. Although PBM implementation may seem complex and daunting, it is feasible to start small. Implementing PBM Pillar 1, particularly in preoperative patients, is a sensible first step regardless of the healthcare setting.
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Affiliation(s)
| | - Ai Leen Ang
- Department of Haematology, Singapore General Hospital, Singapore
| | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Discipline of Acute Care Medicine, University of Adelaide, Australia
| | - Axel Hofmann
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland.,Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Australia.,Faculty of Health Sciences, Curtin University Western Australia, Australia
| | - Jun Ho Jang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Woo Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, South Korea
| | - Sigismond Lasocki
- Department of Anesthesiology, Critical Care and Emergency, Angers University Hospital, France
| | - Jeong Jae Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University, South Korea
| | - Shir Ying Lee
- Department of Laboratory Medicine, Haematology Division, National University Hospital, Singapore
| | - Kar Koong Carol Lim
- Department of Obstetrics and Gynaecology, Hospital Sultan Haji Ahmad Shah, Pahang, Malaysia
| | - Gurpal Singh
- Division of Hip and Knee Surgery, National University Hospital, Singapore.,Division of Musculoskeletal Oncology, National University Hospital, Singapore
| | - Donat R Spahn
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Tae Hyun Um
- Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, South Korea
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Gómez-Sánchez A, Fuente-Alonso E. Management of iron deficiency anaemia by the preanaesthesia nurse with respect to perioperative transfusion rates. ENFERMERIA CLINICA 2019; 30:47-52. [PMID: 31006542 DOI: 10.1016/j.enfcli.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 01/28/2019] [Accepted: 02/06/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the prevalence of perioperative blood transfusion (BT) for patients with preoperative iron deficiency anaemia and undergoing major elective surgery, included in an intravenous iron protocol (IV Fe) led by the pre-anaesthesia nurse. METHOD Observational, descriptive, longitudinal and retrospective study in a population of patients undergoing major elective surgery, seen in anaesthesia nursing consultation in a tertiary hospital between April 2014 and January 2017. The patients with iron deficiency anaemia, included in the study, were included in a protocol of treatment with preoperative IV Fe. RESULTS Fifty patients were studied. Twelve percent required a BT. A statistically significant association was observed between the need for intraoperative BT and the number of days between the first administration of IV Fe and date of surgery (P<.01) and also the number of days between the last administration of IV Fe and the surgical intervention (P=.04). The increase in haemoglobin was greater in patients who received more than one dose compared to those who received only one dose of 1,000mg (P<.01). CONCLUSIONS In our study, we estimated an increase in haemoglobin greater than in other studies and a low administration rate of BT (12%). The role of the nurse is fundamental for the preselection of these patients.
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Affiliation(s)
- Ana Gómez-Sánchez
- Unidad de Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | - Elena Fuente-Alonso
- Consulta de Preanestesia, Departamento de Anestesia y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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Cinnella G, Pavesi M, De Gasperi A, Ranucci M, Mirabella L. Clinical standards for patient blood management and perioperative hemostasis and coagulation management. Position Paper of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Minerva Anestesiol 2019; 85:635-664. [PMID: 30762323 DOI: 10.23736/s0375-9393.19.12151-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patient blood management is currently defined as the application of evidence based medical and surgical concepts designed to maintain hemoglobin (Hb), optimize hemostasis and minimize blood loss to improve patient outcome. Blood management focus on the perioperative management of patients undergoing surgery or other invasive procedures in which significant blood loss occurs or is expected. Preventive strategies are emphasized to identify and manage anemia, reduce iatrogenic blood losses, optimize hemostasis (e.g. pharmacologic therapy, and point of care testing); establish decision thresholds for the appropriate administration of blood therapy. This goal was motivated historically by known blood risks including transmissible infectious disease, transfusion reactions, and potential effects of immunomodulation. Patient blood management has been recognized by the World Health Organization (WHO) as the new standard of care and has urged all 193-member countries of WHO to implement this concept. There is a pressing need for this new "standard of care" so as to reduce blood transfusion and promote the availability of transfusion alternatives. Patient blood management therefore encompasses an evidence-based medical and surgical approach that is multidisciplinary (transfusion medicine specialists, surgeons, anesthesiologists, and critical care specialists) and multiprofessional (physicians, nurses, pump technologists and pharmacists). The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) organized a consensus project involving a Task Force of expert anesthesiologists that reviewing literature provide appropriate levels of care and good clinical practices. Hence, this article focuses on achieving goals of PBM in the perioperative period.
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Affiliation(s)
- Gilda Cinnella
- Unit of Anesthesia and Resuscitation, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Marco Pavesi
- Division of Multispecialty Anesthesia Service of Polispecialistic Anesthesia, San Donato IRCCS Polyclinic, San Donato Milanese, Milan, Italy
| | - Andrea De Gasperi
- Division of Anesthesia and Resuscitation, Niguarda Hospital, Milan, Italy
| | - Marco Ranucci
- Division of Anesthesia and Cardio-Thoraco-Vascular Therapy, San Donato IRCCS Polyclinic, San Donato Milanese, Milan, Italy
| | - Lucia Mirabella
- Unit of Anesthesia and Resuscitation, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy -
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Sperling D, Freudenschuss B, Shrestha A, Hinney B, Karembe H, Joachim A. Comparative efficacy of two parenteral iron-containing preparations, iron gleptoferron and iron dextran, for the prevention of anaemia in suckling piglets. Vet Rec Open 2018; 5:e000317. [PMID: 30613406 PMCID: PMC6307558 DOI: 10.1136/vetreco-2018-000317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 01/14/2023] Open
Abstract
Iron-deficiency anaemia (IDA) is a serious health problem in neonatal piglets and is controlled by routine application of iron in various formulations. The efficacy and safety of two iron-containing products for the prevention of IDA in suckling piglets were compared in a randomised, parallel study. Newborn piglets were treated with 200 mg iron supplied by intramuscular injection in the neck as either Forceris (gleptoferron; n=13) or Uniferon 200 (iron dextran; n=12) 24–48 hours after birth. Blood samples were collected before and after treatment (2nd, 18th and 31st day of life) for complete haematology. The treatments were well tolerated with only mild transient swelling observed in two piglets (Forceris group). Piglets treated with Forceris had significantly higher haemoglobin, haematocrit, mean corpuscular volume and haemoglobin concentration values, as well as significantly higher plasma iron and transferritin saturation and a lower total iron binding capacity than those treated with Uniferon. No animals in the Forceris group but 17 per cent of piglets in the Uniferon group had haemoglobin levels <9 g/dl after treatment, indicating anaemia. These results suggest that both products were safe and effective in the prophylaxis of IDA in piglets, and that Forceris was superior to Uniferon in preventing IDA in piglets.
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Affiliation(s)
| | - Barbara Freudenschuss
- Department of Pathobiology, Institute of Parasitology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Aruna Shrestha
- Department of Pathobiology, Institute of Parasitology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Barbara Hinney
- Department of Pathobiology, Institute of Parasitology, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | - Anja Joachim
- Department of Pathobiology, Institute of Parasitology, University of Veterinary Medicine Vienna, Vienna, Austria
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11
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Nguyen PVQ, Latour J. Ferric Gluconate Complex in Elderly Hospital Inpatients without Terminal Kidney Failure. Can J Hosp Pharm 2018; 71:173-179. [PMID: 29955190 PMCID: PMC6019086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Anemia is a common health issue for elderly patients. For patients with iron deficiency who cannot tolerate iron supplementation by the oral route, the parenteral route may be used. Options for parenteral iron supplementation include ferric gluconate complex (FGC). OBJECTIVES To evaluate the safety of FGC in elderly patients without terminal kidney failure and to assess its efficacy in treating iron-deficiency anemia. METHODS An observational chart review was conducted at a tertiary care university health centre. Patients included in the study were 65 years of age or older, had received at least 1 dose of FGC between January 1, 2014, and December 31, 2015, and had a hemoglobin count of less than 130 g/L (men) or less than 120 g/L (women) at baseline. For each patient, the observation period began when the first dose of FGC was administered and ended 60 days after the last dose. The main safety outcome (occurrence of any adverse reaction) was evaluated for every patient, with the efficacy analysis being limited to patients with a diagnosis of iron-deficiency anemia. RESULTS A total of 144 patients were included in the study, of whom 76 had iron-deficiency anemia. No serious, life-threatening adverse reactions were reported. The most commonly reported adverse reactions were nausea and vomiting. The mean increase in hemoglobin count was 13.5 g/L, a statistically significant change from baseline. CONCLUSIONS These results show that FGC is safe for use in elderly patients, with very few mild adverse reactions. Use of FGC led to increased hemoglobin count within 60 days. Of the 3 options for parenteral iron supplementation available in Canada, iron sucrose has not been studied in elderly patients, and iron dextran has a higher incidence of anaphylaxis, whereas FGC appears to be a safe alternative for patients with intolerance to oral iron.
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Affiliation(s)
- Patrick Viet-Quoc Nguyen
- , MSc, is a Pharmacist with the Centre hospitalier de l'Université de Montréal (CHUM) and the CHUM Research Center, Montréal, Quebec
| | - Judith Latour
- , MD, is a Geriatrician with the Centre hospitalier de l'Université de Montréal, Montréal, Quebec
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Butcher A, Richards T. Cornerstones of patient blood management in surgery. Transfus Med 2017; 28:150-157. [PMID: 28940786 DOI: 10.1111/tme.12476] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/11/2017] [Accepted: 08/28/2017] [Indexed: 12/22/2022]
Abstract
Pre-operative anaemia and perioperative red blood cell transfusion carry significant consequence when it comes to surgical outcomes. The establishment of patient-centred clinical pathways has been designed to harness and endorse good transfusion practice, termed the three pillars of patient blood management (PBM). These focus on the timely and appropriate management of anaemia, prevention of blood loss and restrictive transfusion where appropriate. This article reviews the current evidence and ongoing research in the field of PBM in surgery. Strategies to implement PBM have shown significant benefits in appropriate transfusion practice, reduced costs and improved length of hospital stay. Recently published national quality standards have recognised the features of the PBM blueprint such as the consideration of alternatives to red blood cell transfusion, the active measures to reduce perioperative blood loss and the appropriate management of post-operative anaemia. Adopting PBM in surgical patients should be paramount to reduce the risks posed by perioperative anaemia and blood transfusions. The principles of PBM help structure the interventions and decisions relating to anaemia and blood transfusion, but, more importantly, represent a paradigm shift towards a more considered approach to blood transfusion, acknowledging its risks, preventatives and alternatives.
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Affiliation(s)
- A Butcher
- Division of Surgery and Interventional Science, University College London, London, UK
| | - T Richards
- Division of Surgery and Interventional Science, University College London, London, UK
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13
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Song JH, Park JW, Lee YK, Kim IS, Nho JH, Lee KJ, Park KK, Kim Y, Park JH, Han SB. Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus. Hip Pelvis 2017; 29:81-90. [PMID: 28611958 PMCID: PMC5465399 DOI: 10.5371/hp.2017.29.2.81] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/29/2017] [Accepted: 05/01/2017] [Indexed: 12/22/2022] Open
Abstract
The volume of hip arthroplasty is stiffly increasing because of excellent clinical outcomes, however it has not been shown to decrease the incidence of transfusions due to bleeding related to this surgery. This is an important consideration since there are concerns about the side effects and social costs of transfusions. First, anemia should be assessed at least 30 days before elective hip arthroplasty, and if the subject is diagnosed as having anemia, an additional examination of the cause of the anemia should be carried and steps taken to address the anemia. Available iron treatments for anemia take 7 to 10 days to facilitate erythropoiesis, and preoperative iron supplementation, either oral or intravenous, is recommended. When using oral supplements for iron storage, administer elemental iron 100 mg daily for 2 to 6 weeks before surgery, and calculate the dose using intravenous supplement. Tranexamic acid (TXA) is a synthetic derivative of the lysine component, which reduces blood loss by inhibiting fibrinolysis and clot degradation. TXA is known to be an effective agent for reducing postoperative bleeding and reducing the need for transfusions in primary and revision total hip arthroplasties. Patient blood management has improved the clinical outcome after hip arthroplasty through the introduction and research of various agents, thereby reducing the need for allogeneic blood transfusions and reducing the risk of transfusion-related infections and the duration of hospitalizations.
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Affiliation(s)
- Joo-Hyoun Song
- Department of Orthopaedics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jang Won Park
- Department of Orthopaedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Sung Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jae-Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital, Seoul, Korea
| | - Kyung-Jae Lee
- Department of Orthopaedic Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Kwan Kyu Park
- Department of Orthopaedic surgery, Yonsei University, College of Medicine, Seoul, Korea
| | - Yeesuk Kim
- Department of Orthopaedic Surgery, School of Medicine, Hanyang University, Seoul, Korea
| | - Jai Hyung Park
- Department of Orthopaedic surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Korea
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Halawi R, Moukhadder H, Taher A. Anemia in the elderly: a consequence of aging? Expert Rev Hematol 2017; 10:327-335. [DOI: 10.1080/17474086.2017.1285695] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Racha Halawi
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Hassan Moukhadder
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Ali Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
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15
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Affiliation(s)
| | - Jonathan Bromley
- Consultant physician, Gastroenterologist and General Medicine, Canberra Hospital
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16
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Vaglio S, Prisco D, Biancofiore G, Rafanelli D, Antonioli P, Lisanti M, Andreani L, Basso L, Velati C, Grazzini G, Liumbruno GM. Recommendations for the implementation of a Patient Blood Management programme. Application to elective major orthopaedic surgery in adults. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:23-65. [PMID: 26710356 PMCID: PMC4731340 DOI: 10.2450/2015.0172-15] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
- Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianni Biancofiore
- Liver Transplant Anaesthesia and Critical Care, University Hospital Pisana, Pisa, Italy
| | - Daniela Rafanelli
- Immunohaematology and Transfusion Unit, Pistoia 3 Local Health Authority, Pistoia, Italy
| | - Paola Antonioli
- Department of Infection Prevention Control and Risk Management, Ferrara University Hospital, Ferrara, Italy
| | - Michele Lisanti
- 1 Orthopaedics and Trauma Section, University Hospital Pisana, Pisa, Italy
| | - Lorenzo Andreani
- 1 Orthopaedics and Trauma Section, University Hospital Pisana, Pisa, Italy
| | - Leonardo Basso
- Orthopaedics and Trauma Ward, Cottolengo Hospital, Turin, Italy
| | - Claudio Velati
- Transfusion Medicine and Immunohaematology Department of Bologna Metropolitan Area, Bologna, Italy, on behalf of Italian Society of Transfusion Medicine and Immunohaematology (SIMTI); Italian Society of Italian Society of Orthopaedics and Traumatology (SIOT); Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Therapy (S.I.A.A.R.T.I.); Italian Society for the Study of Haemostasis and Thrombosis (SISET), and the National Association of Hospital Medical Directors (ANMDO) working group
| | - Giuliano Grazzini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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17
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Ma Y, Wang M, Li D, Pan H, Liu H. Physicochemical Properties, Characterization, and Antioxidant Activity of Sodium Ferric Gluconate Complex. FOOD SCIENCE AND TECHNOLOGY RESEARCH 2016. [DOI: 10.3136/fstr.22.639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Yixuan Ma
- Chongqing Engineering Research Center for Pharmaceutical Process and Quality Control, College of Pharmaceutical Sciences, Southwest University
| | - Miao Wang
- Chongqing Engineering Research Center for Pharmaceutical Process and Quality Control, College of Pharmaceutical Sciences, Southwest University
| | - Dan Li
- Chongqing Engineering Research Center for Pharmaceutical Process and Quality Control, College of Pharmaceutical Sciences, Southwest University
| | - Hongchun Pan
- Chongqing Engineering Research Center for Pharmaceutical Process and Quality Control, College of Pharmaceutical Sciences, Southwest University
| | - Hong Liu
- Chongqing Engineering Research Center for Pharmaceutical Process and Quality Control, College of Pharmaceutical Sciences, Southwest University
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18
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Clevenger B, Mallett SV, Klein AA, Richards T. Patient blood management to reduce surgical risk. Br J Surg 2015; 102:1325-37; discussion 1324. [PMID: 26313653 DOI: 10.1002/bjs.9898] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preoperative anaemia and perioperative blood transfusion are both identifiable and preventable surgical risks. Patient blood management is a multimodal approach to address this issue. It focuses on three pillars of care: the detection and treatment of preoperative anaemia; the reduction of perioperative blood loss; and harnessing and optimizing the patient-specific physiological reserve of anaemia, including restrictive haemoglobin transfusion triggers. This article reviews why patient blood management is needed and strategies for its incorporation into surgical pathways. METHODS Studies investigating the three pillars of patient blood management were identified using PubMed, focusing on recent evidence-based guidance for perioperative management. RESULTS Anaemia is common in surgical practice. Both anaemia and blood transfusion are independently associated with adverse outcomes. Functional iron deficiency (iron restriction due to increased levels of hepcidin) is the most common cause of preoperative anaemia, and should be treated with intravenous iron. Intraoperative blood loss can be reduced with antifibrinolytic drugs such as tranexamic acid, and cell salvage should be used. A restrictive transfusion practice should be the standard of care after surgery. CONCLUSION The significance of preoperative anaemia appears underappreciated, and its detection should lead to routine investigation and treatment before elective surgery. The risks of unnecessary blood transfusion are increasingly being recognized. Strategic adoption of patient blood management in surgical practice is recommended, and will reduce costs and improve outcomes in surgery.
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Affiliation(s)
- B Clevenger
- Division of Surgery and Interventional Science, University College London, London, UK.,Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free Hospital, London, UK
| | - S V Mallett
- Division of Surgery and Interventional Science, University College London, London, UK.,Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free Hospital, London, UK
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | - T Richards
- Division of Surgery and Interventional Science, University College London, London, UK
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Efficacy and Safety of Intravenous Ferric Carboxymaltose in Geriatric Inpatients at a German Tertiary University Teaching Hospital: A Retrospective Observational Cohort Study of Clinical Practice. Anemia 2015; 2015:647930. [PMID: 26236500 PMCID: PMC4506836 DOI: 10.1155/2015/647930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 06/07/2015] [Accepted: 06/17/2015] [Indexed: 02/07/2023] Open
Abstract
Current iron supplementation practice in geriatric patients is erratic and lacks evidence-based recommendations. Despite potential benefits in this population, intravenous iron supplementation is often withheld due to concerns regarding pharmacy expense, perceived safety issues, and doubts regarding efficacy in elderly patients. This retrospective, observational cohort study aimed to evaluate the safety and efficacy of intravenous ferric carboxymaltose (FCM, Ferinject) in patients aged >75 years with iron deficiency anaemia (IDA). Within a twelve-month data extraction period, the charts of 405 hospitalised patients aged 65–101 years were retrospectively analysed for IDA, defined according to WHO criteria for anaemia (haemoglobin: <13.0 g/dL (m)/<12.0 g/dL (f)) in conjunction with transferrin saturation <20%. Of 128 IDA patients screened, 51 (39.8%) received intravenous iron. 38 patient charts were analysed. Mean cumulative dose of intravenous FCM was 784.4 ± 271.7 mg iron (1–3 infusions). 18 patients (47%) fulfilled treatment response criteria (≥1.0 g/dL increase in haemoglobin between baseline and hospital discharge). AEs were mild/moderate, most commonly transient increases of liver enzymes (n = 5/13.2%). AE incidence was comparable with that observed in patients <75 years. No serious AEs were observed. Ferric carboxymaltose was well tolerated and effective for correction of Hb levels and iron stores in this cohort of IDA patients aged over 75 years.
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Powers JM, McCavit TL, Buchanan GR. Management of iron deficiency anemia: a survey of pediatric hematology/oncology specialists. Pediatr Blood Cancer 2015; 62:842-6. [PMID: 25663613 PMCID: PMC4376588 DOI: 10.1002/pbc.25433] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/23/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Iron deficiency anemia (IDA) is the most common hematologic condition in children and adolescents in the United States (US). No prior reports have described the management of IDA by a large cohort of pediatric hematology/oncology specialists. PROCEDURE A 20-question electronic survey that solicited responses to two hypothetical cases of IDA was sent to active members of the American Society of Pediatric Hematology/Oncology (ASPHO) in the US. RESULTS Of 1,217 recipients, 398 (32.7%) reported regularly treating IDA and completed the survey. In a toddler with nutritional IDA, 15% (N = 61) of respondents reported ordering no diagnostic test beyond a complete blood count. Otherwise, wide variability in laboratory testing was reported. For treatment, most respondents would prescribe ferrous sulfate (N = 335, 84%) dosed at 6 mg/kg/day (N = 248, 62%) divided twice daily (N = 272, 68%). The recommended duration of iron treatment after resolution of anemia and normalized serum ferritin varied widely from 0 to 3 months. For an adolescent with heavy menstrual bleeding and IDA, most respondents recommended ferrous sulfate (N = 327, 83%), with dosing based on the number of tablets daily. For IDA refractory to oral treatment, intravenous iron therapy was recommended most frequently, 48% (N = 188) using iron sucrose, 17% (N = 68) ferric gluconate, and 15% (N = 60) low molecular weight iron dextran. CONCLUSION The approach to diagnosis and treatment of IDA in childhood was widely variable among responding ASPHO members. Given the lack of an evidence base to guide clinical decision making, further research investigating IDA management is needed.
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Affiliation(s)
- Jacquelyn M. Powers
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Timothy L. McCavit
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX,Children’s Medical Center, Dallas, TX
| | - George R. Buchanan
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX,Children’s Medical Center, Dallas, TX
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21
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Clevenger B, Richards T. Pre-operative anaemia. Anaesthesia 2015; 70 Suppl 1:20-8, e6-8. [PMID: 25440391 DOI: 10.1111/anae.12918] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 12/21/2022]
Abstract
Pre-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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Affiliation(s)
- B Clevenger
- Division of Surgery and Interventional Science, Royal Free Hospital, University College London, London, UK
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22
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Abstract
Perioperative anaemia and allogenic blood transfusion (ABT) are known to increase the risk of adverse clinical outcomes. The quality, cost and availability of blood components are also major limitations with regard to ABT. Perioperative patient blood management (PBM) strategies should be aimed at minimizing and improving utilization of blood components. The goals of PBM are adequate preoperative evaluation and optimization of haemoglobin and bleeding parameters, techniques to minimize blood loss, blood conservation technologies and use of transfusion guidelines with targeted therapy. Attention to these details can help in cost reduction and improved patient outcome.
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Affiliation(s)
- M Manjuladevi
- Department of Anesthesia and Critical Care, St. John's Medical College and Hospital, Johnnagara, Bengaluru, Karnataka, India
| | - KS Vasudeva Upadhyaya
- Department of Anesthesia and Critical Care, St. John's Medical College and Hospital, Johnnagara, Bengaluru, Karnataka, India
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23
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Busti F, Campostrini N, Martinelli N, Girelli D. Iron deficiency in the elderly population, revisited in the hepcidin era. Front Pharmacol 2014; 5:83. [PMID: 24795637 PMCID: PMC4006029 DOI: 10.3389/fphar.2014.00083] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/04/2014] [Indexed: 12/13/2022] Open
Abstract
Iron deficiency (ID) is relatively common among the elderly population, contributing substantially to the high prevalence of anemia observed in the last decades of life, which in turn has important implications both on quality of life and on survival. In elderly subjects, ID is often multifactorial, i.e., due to multiple concurring causes, including inadequate dietary intake or absorption, occult bleeding, medications. Moreover, because of the typical multimorbidity of aged people, other conditions leading to anemia frequently coexist and make diagnosis of ID particularly challenging. Treatment of ID is also problematic in elderly, since response to oral iron is often slow, with a substantial fraction of patients showing refractoriness and requiring cumbersome intravenous administration. In the last decade, the discovery of the iron regulatory hormone hepcidin has revolutionized our understanding of iron pathophysiology. In this review, we revisit ID among elderly people in the light of the impressive recent advances on knowledge of iron regulation, and discuss how hepcidin may help in diagnosis and treatment of this common clinical condition.
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Double bull's eye for post-operative intravenous iron in patient blood management: better outcome and cost-effective. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:7-9. [PMID: 24333091 DOI: 10.2450/2013.0227-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Endoscopic gastrointestinal workup fails to establish the cause of iron deficiency anemia (IDA) in a substantial proportion of patients. In patients referred for hematologic evaluation with unexplained or refractory IDA, screening for celiac disease, autoimmune gastritis, Helicobacter pylori, and hereditary forms of IDA is recommended. About 4% to 6% of patients with obscure refractory IDA have celiac disease, and autoimmune gastritis is encountered in 20% to 27% of patients. Stratification by age cohorts in autoimmune gastritis implies a disease presenting as IDA many years before the establishment of clinical cobalamin deficiency. Over 50% of patients with unexplained refractory IDA have active H pylori infection and, after excluding all other causes of IDA, 64% to 75% of such patients are permanently cured by H pylori eradication. In young patients with a history suggestive of hereditary iron deficiency with serum ferritin higher than expected for IDA, mutations involving iron trafficking and regulation should be considered. Recognition of the respective roles of H pylori, autoimmune gastritis, celiac disease, and genetic defects in the pathogenesis of iron deficiency should have a strong impact on the current diagnostic workup and management of unexplained, or refractory, IDA.
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Current Management of Iron Deficiency Anemia in Inflammatory Bowel Diseases: A Practical Guide. Drugs 2013; 73:1761-70. [DOI: 10.1007/s40265-013-0131-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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