[Anemia and transfusion therapy: an update]

Anaemia in patients undergoing major bowel surgery - Prevalence and current practice: A public and private institution experience

AIM

The study aimed to compare the frequency and alignment of preoperative anaemia screening and treatment with Australian guidelines in elective bowel surgery and determine the impact on clinical outcomes.

METHODS

We performed a retrospective observational study, with an audit of 559 adult patients who underwent major elective bowel surgery in an Australian metropolitan hospital, January 2016-December 2018. Outcome measures included rate of anaemia, guideline compliance, hospital length of stay, and transfusion rate.

RESULTS

Preoperative anaemia assessment occurred in 82.6% of patients. However, only 5.2% received recommended biochemical tests at least one week before surgery. Only 25.2% of anaemic patients received preoperative treatment; they experienced a longer hospital length of stay (9.93 days versus 7.88 days, p < 0.001) and an increased rate of transfusion (OR: 3.186, p < 0.05).

CONCLUSION

The gaps between current preoperative anaemia screening, management and national guidelines may place patients at higher risk of poor surgical outcome.

Blood volume extracted from the critical patient in the first 24 hours after admission

OBJECTIVE

To calculate the number of analytical tests and blood volume drawn during the first 24hours of admission to the Intensive Care Unit (ICU). To analyse values of basal haemoglobin and at 24hours, relate them to blood loss, weight variation, and scoring system.

METHOD

An observational descriptive pilot study. Variables studied: age, sex, diagnosis on admission, analytical tests extracted, waste quantity before the extraction of samples, total volume blood extracted in 24hours, weight variation, APACHE, SAPS, basal haemoglobin and at 24hours. Statistical analysis with SPSS vs 20.0. Variables correlation sex, weight variation, the number of analytical tests and haemoglobin change.

RESULTS

The study included 100 patients. The average number of extractions per patient/day was 7.2 (±2.6). The average waste quantity was 32.61ml (±15.8). The blood volume used for determinations was 48.18ml / 24h (±16.74). The haemoglobin value decreased in the first 24hours of admission, being higher in men (P<.05). The scoring systems were statistically significant for levels of haemoglobin (Hb1 -0.3; P=.001; Hb2 -0.4; P=.001).

CONCLUSIONS

Of the total volume of blood extracted in ICU, 40% belongs to a volume of waste and 60% of blood is used for analytical tests. There is a decrease in haemoglobin exists 24hours after admission of the critical patient. Statistically, it has not been possible to demonstrate its relation with the number of analytical tests.

[The multidisciplinary approach is useful for optimising preoperative haemoglobin in colorectal cancer surgery]

INTRODUCTION

Optimising haemoglobin (Hb) levels less than 13 g/dl in the preoperative period can reduce the transfusion rate. With this aim, we developed a multidisciplinary protocol in our hospital for the treatment of patients proposed for colorectal cancer surgery.

PATIENTS AND METHOD

A study was conducted on 437 patients who had surgery performed for colorectal cancer in the period 2005-2009. The data recorded were: demographic data, Hb and iron metabolism (Fe) at the time of diagnosis, Hb on the day of the surgery and on discharge, tumour location, preoperative adjuvant treatment (chemotherapy and/or radiotherapy), tumour stage (TNM), iron treatment, transfusion rate, and complications at 30 days. Patients were classified into Group A; Hb < 13 g/dl and/or abnormal Fe metabolism, and Group B; Hb > 13 g/dl and/or normal Fe metabolism.

RESULTS

Of the total, 53.3% were in Group B and were treated with Fe; 73.6% intravenous (IV), and the rest oral. The mean dose of IV Fe was 867 mg. The mean intraindividual difference between the Hb on the day of surgery and at the initial value, increased by 0.6g/dl in Group A, while it decreased by 0.8 g/dl in Group B. The mean intraindividual difference between the Hb at discharge and the diagnosis decreased by 0.4 g/dl in Group A compared to 2.5 g/dl in Group B. The overall transfusion rate was 8.6%. No statistically significant differences were observed in complications.

CONCLUSIONS

A multidisciplinary and early treatment of colorectal cancer enables patients with a low haemoglobin (Group A) to be optimised, as well as achieving a lower transfusion rate.