Transfusión sanguínea perioperatoria en el paciente neoplásico. I. Alteraciones inmunológicas y consecuencias clínicas

[Prevalence and treatment of anemia in critically ill patients]

Anemia is a common condition among medical and surgical patients admitted to the intensive care unit (ICU) and generally has a multifactorial origin. In order to avoid the deleterious effects of anemia, 40% of ICU patients receive allogenic blood transfusion (ABT). This figure increases up to 70% if the ICU stay is longer than 7 days. However, ABT is associated with a dose-dependent increase in morbidity and mortality. In contrast, the administration of exogenous erythropoietin plus iron supplements, especially iv iron, improves anemia and reduces ABT requirements, although it does not reduce mortality. To ascertain whether treatment of anemia in the critically ill with exogenous erythropoietin and iron might improve outcomes and to optimize drug administration schedules and dosage, further studies with sufficient statistical power and adequate follow-up are warranted.

Hierro por vía intravenosa en cirugía general

Preoperative anemia is the main cause of blood transfusion in surgical patients. In digestive surgery high blood loss and allogenic blood transfusion (ABT) are associated with serious adverse events and higher mortality. Consequently, we believe that intravenous iron administration is justified to correct perioperative anemia. We present the case of a woman with metastatic colorectal adenocarcinoma in whom intravenous iron administration avoided the use of ABT. Subsequently, the iron metabolism profile improved. This had previously corresponded to a mixed pattern of iron deficiency, that is, to the association of organic and functional iron deficiency.