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Correction of iron-deficiency anaemia in colorectal surgery reduces perioperative transfusion rates: A before and after study. Int J Surg 2017; 38:1-8. [DOI: 10.1016/j.ijsu.2016.12.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/06/2016] [Accepted: 12/10/2016] [Indexed: 11/23/2022]
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Leal-Noval SR, Muñoz M, Asuero M, Contreras E, García-Erce JA, Llau JV, Moral V, Páramo JA, Quintana M, Basora M, Bautista-Paloma FJ, Bisbe E, Bóveda JL, Castillo-Muñoz A, Colomina MJ, Fernández C, Fernández-Mondéjar E, Ferrándiz C, García de Lorenzo A, Gomar C, Gómez-Luque A, Izuel M, Jiménez-Yuste V, López-Briz E, López-Fernández ML, Martín-Conde JA, Montoro-Ronsano B, Paniagua C, Romero-Garrido JA, Ruiz JC, Salinas-Argente R, Sánchez C, Torrabadella P, Arellano V, Candela A, Fernández JA, Fernández-Hinojosa E, Puppo A. [The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. Med Intensiva 2013; 37:259-83. [PMID: 23507335 DOI: 10.1016/j.medin.2012.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 12/12/2012] [Accepted: 12/19/2012] [Indexed: 02/06/2023]
Abstract
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?» All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
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Affiliation(s)
- S R Leal-Noval
- Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias.
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Leal-Noval SR, Muñoz M, Asuero M, Contreras E, García-Erce JA, Llau JV, Moral V, Páramo JA, Quintana M, Basora M, Bautista-Paloma FJ, Bisbe E, Bóveda JL, Castillo-Muñoz A, Colomina MJ, Fernández C, Fernández-Mondéjar E, Ferrándiz C, García de Lorenzo A, Gomar C, Gómez-Luque A, Izuel M, Jiménez-Yuste V, López-Briz E, López-Fernández ML, Martín-Conde JA, Montoro-Ronsano B, Paniagua C, Romero-Garrido JA, Ruiz JC, Salinas-Argente R, Sánchez C, Torrabadella P, Arellano V, Candela A, Fernández JA, Fernández-Hinojosa E, Puppo A. [The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. ACTA ACUST UNITED AC 2013; 60:263.e1-263.e25. [PMID: 23415109 DOI: 10.1016/j.redar.2012.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/12/2012] [Indexed: 12/21/2022]
Abstract
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
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Affiliation(s)
- S R Leal-Noval
- Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC).
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Garg M, Morrison G, Friedman A, Lau A, Lau D, Gibson PR. A rapid infusion protocol is safe for total dose iron polymaltose: time for change. Intern Med J 2011; 41:548-54. [DOI: 10.1111/j.1445-5994.2010.02356.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Díaz Espallardo C, Laso Morales MJ, Colilles Calvet C, Mora López L, Roig Martínez I, Martínez Marín MT. [The multidisciplinary approach is useful for optimising preoperative haemoglobin in colorectal cancer surgery]. Cir Esp 2011; 89:392-9. [PMID: 21453911 DOI: 10.1016/j.ciresp.2011.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/31/2010] [Accepted: 01/26/2011] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Carmen Díaz Espallardo
- Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
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Madrazo González Z, García Barrasa A, Rafecas Renau A. Anemia, hierro, transfusión y alternativas terapéuticas. Revisión desde una perspectiva quirúrgica. Cir Esp 2010; 88:358-68. [DOI: 10.1016/j.ciresp.2010.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 11/27/2009] [Accepted: 03/12/2010] [Indexed: 12/31/2022]
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Mearin F, Balboa A, Castells A, Domínguez JE, Esteve M, García-Erce JA, Pérez Gisbert J, Gomollón F, Panés J, Ponce J. Anemia ferropénica y uso de hierro endovenoso en patología digestiva. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:605-13. [DOI: 10.1016/j.gastrohep.2010.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 08/03/2010] [Indexed: 12/19/2022]
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Gomollón F, Gisbert JP, García-Erce JA. Intravenous iron in digestive diseases: a clinical (re)view. Ther Adv Chronic Dis 2010; 1:67-75. [PMID: 23251730 PMCID: PMC3513858 DOI: 10.1177/2040622310373675] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Intravenous iron has been considered dangerous by many clinicians. In the last two decades, considerable experience has been gained with new formulations in different clinical settings. Data from clinical trials, observational studies, and postmarketing surveillance studies demonstrate that intravenous iron is safe and effective to treat iron deficiency and iron deficiency anaemia. Iron deficiency is particularly common in many digestive diseases: oral iron often fails while transfusions are not without considerable risks. In particular, in inflammatory bowel diseases, there is enough evidence to recommend intravenous iron in moderate-to-severe iron deficiency anaemia, in intolerance to oral iron, and in patients needing quick recovery (pre-operative setting). New formulations make treatment even easier and more convenient. Recent guidelines are available for inflammatory bowel diseases, and new guidelines in acute and chronic gastrointestinal bleeding are needed.
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Affiliation(s)
- Fernando Gomollón
- Correspondence to: Fernando Gomollón, MD, PhD Servicio de Aparato Digestivo, Hospital Clínico Universitario ‘Lozano Blesa', Avenida San Juan Bosco 15, 50009 Zaragoza, CIBEREHD, Spain
| | - Javier P. Gisbert
- Javier P. Gisbert, MD, PhD Digestive Diseases Service, Hospital ‘La Princesa', Madrid, CIBEREHD, Spain
| | - José Antonio García-Erce
- José Antonio García-Erce, MD, PhD Department of Haematology and Haemotherapy, Hospital Universitario ‘Miguel Servet', Zaragoza, Spain
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Shander A, Spence RK, Auerbach M. Can intravenous iron therapy meet the unmet needs created by the new restrictions on erythropoietic stimulating agents? Transfusion 2009; 50:719-32. [PMID: 19919555 DOI: 10.1111/j.1537-2995.2009.02492.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In 2008, after reports of an association between erythropoietic stimulating agent (ESA) therapy and the potential for either thrombotic cardiovascular events or more rapid tumor progression in some cancers, the Food and Drug Administration changed the product labeling for ESAs, adding a black box warning as well as more restrictive indications, especially in oncology patients. In addition the Centers for Medicare and Medicaid Services has placed significant restrictions on payments for ESA therapy. These new limitations on ESA have led to increased use of transfusions in anemic cancer patients. This increase in allogeneic transfusions potentially will place an additional burden on the US blood supply. Although allogeneic blood transfusion is one answer to ESA restrictions, the use of intravenous iron therapy (IV iron) is another possible alternative. We will discuss the use of IV iron as primary therapy for anemia, the use of combination IV iron and ESA therapy to improve efficiency and decrease costs, and evidence that IV iron with and without ESA therapy can reduce allogeneic blood transfusions in surgical patients. We will also review the available IV iron agents and their comparative safety profiles.
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Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA
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Beris P, Muñoz M, García-Erce J, Thomas D, Maniatis A, Van der Linden P. Perioperative anaemia management: consensus statement on the role of intravenous iron. Br J Anaesth 2008; 100:599-604. [DOI: 10.1093/bja/aen054] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Muñoz M, Breymann C, García-Erce JA, Gómez-Ramírez S, Comin J, Bisbe E. Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion. Vox Sang 2008; 94:172-183. [PMID: 18069918 DOI: 10.1111/j.1423-0410.2007.01014.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anaemia is a common condition among patients admitted to hospital medicosurgical departments, as well as in critically ill patients. Anaemia is more frequently due to absolute iron deficiency (e.g. chronic blood loss) or functional iron deficiency (e.g. chronic inflammatory states), with other causes being less frequent. In addition, preoperative anaemia is one of the major predictive factors for perioperative blood transfusion. In surgical patients, postoperative anaemia is mainly caused by perioperative blood loss, and it might be aggravated by inflammation-induced inhibition of erythropoietin and functional iron deficiency (a condition that cannot be corrected by the administration of oral iron). All these mechanisms may be involved in the anaemia of the critically ill. Intravenous iron administration seems to be safe, as very few severe side-effects were observed, and may result in hastened recovery from anaemia and lower transfusion requirements. However, it is noteworthy that many of the recommendations given for intravenous iron treatment are not supported by a high level of evidence and this must be borne in mind when making decisions regarding its application to a particular patient. Nonetheless, this also indicates the need for further large, randomized controlled trials on the safety and efficacy of intravenous iron for the treatment of anaemia in different clinical settings.
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Affiliation(s)
- M Muñoz
- Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain
| | - C Breymann
- Feto Maternal Haematology Research Group, University Hospital Zurich, Zurich, Switzerland
| | - J A García-Erce
- Department of Haematology, University Hospital Miguel Servet, Zaragoza, Spain
| | - S Gómez-Ramírez
- Department of Internal Medicine, University Hospital Virgen de la Victoria, Málaga, Spain
| | - J Comin
- Departments of Cardiology and
| | - E Bisbe
- Anaesthesiology, Hospital Mar-Esperanza, Barcelona, Spain
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Auerbach M, Goodnough LT, Picard D, Maniatis A. The role of intravenous iron in anemia management and transfusion avoidance. Transfusion 2008; 48:988-1000. [PMID: 18346021 DOI: 10.1111/j.1537-2995.2007.01633.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Auerbach M, Goodnough LT, Picard D, Maniatis A. The role of intravenous iron in anemia management and transfusion avoidance. Transfusion 2008. [DOI: 10.1111/j.1537-2995.2007.01633.x-i2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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DIEZ-LOBO ANAI, FISAC-MARTÍN MARÍAP, BERMEJO-AYCAR IGNACIO, MUÑOZ MANUEL. Preoperative intravenous iron administration corrects anemia and reduces transfusion requirement in women undergoing abdominal hysterectomy. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1778-428x.2007.00060.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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