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Kumar M, Hepner DL, Grawe ES, Keshock M, Khambaty M, Patel MS, Sweitzer B. Diagnosis and Treatment of Perioperative Anemia: A Society for Perioperative Assessment and Quality Improvement Collaborative Review. Anesthesiology 2024:141986. [PMID: 39264293 DOI: 10.1097/aln.0000000000005111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Anemia is common in presurgical patients and is associated with poor clinical outcomes, even without erythrocyte transfusion. Structured preoperative programs for anemia management are associated with fewer blood transfusions, increased hemoglobin concentrations, and improved outcomes.
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Affiliation(s)
- Mandeep Kumar
- Division of Perioperative Medicine, Hartford Healthcare, Hartford, Connecticut, and University of Connecticut, Farmington, Connecticut
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erin S Grawe
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Maureen Keshock
- Department of Anesthesiology, Cleveland Clinic Foundation, Medina, Ohio
| | - Maleka Khambaty
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Manish S Patel
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - BobbieJean Sweitzer
- Department of Anesthesiology and Surgical Services, Inova Health Foundation, Falls Church, Virginia; and Department of Medical Education, University of Virginia, Charlottesville, Virginia
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A New Artificial Intelligence Approach Using Extreme Learning Machine as the Potentially Effective Model to Predict and Analyze the Diagnosis of Anemia. Healthcare (Basel) 2023; 11:healthcare11050697. [PMID: 36900702 PMCID: PMC10000789 DOI: 10.3390/healthcare11050697] [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: 01/18/2023] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
The procedure to diagnose anemia is time-consuming and resource-intensive due to the existence of a multitude of symptoms that can be felt physically or seen visually. Anemia also has several forms, which can be distinguished based on several characteristics. It is possible to diagnose anemia through a quick, affordable, and easily accessible laboratory test known as the complete blood count (CBC), but the method cannot directly identify different kinds of anemia. Therefore, further tests are required to establish a gold standard for the type of anemia in a patient. These tests are uncommon in settings that offer healthcare on a smaller scale because they require expensive equipment. Moreover, it is also difficult to discern between beta thalassemia trait (BTT), iron deficiency anemia (IDA), hemoglobin E (HbE), and combination anemias despite the presence of multiple red blood cell (RBC) formulas and indices with differing optimal cutoff values. This is due to the existence of several varieties of anemia in individuals, making it difficult to distinguish between BTT, IDA, HbE, and combinations. Therefore, a more precise and automated prediction model is proposed to distinguish these four types to accelerate the identification process for doctors. Historical data were retrieved from the Laboratory of the Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia for this purpose. Furthermore, the model was developed using the algorithm for the extreme learning machine (ELM). This was followed by the measurement of the performance using the confusion matrix and 190 data representing the four classes, and the results showed 99.21% accuracy, 98.44% sensitivity, 99.30% precision, and an F1 score of 98.84%.
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Perioperative Quality Initiative and Enhanced Recovery After Surgery-Cardiac Society Consensus Statement on the Management of Preoperative Anemia and Iron Deficiency in Adult Cardiac Surgery Patients. Anesth Analg 2022; 135:532-544. [PMID: 35977363 DOI: 10.1213/ane.0000000000006148] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Preoperative anemia is common in patients presenting for cardiac surgery, with a prevalence of approximately 1 in 4, and has been associated with worse outcomes including increased risk of blood transfusion, kidney injury, stroke, infection, and death. Iron deficiency, a major cause of anemia, has also been shown to have an association with worse outcomes in patients undergoing cardiac surgery, even in the absence of anemia. Although recent guidelines have supported diagnosing and treating anemia and iron deficiency before elective surgery, details on when and how to screen and treat remain unclear. The Eighth Perioperative Quality Initiative (POQI 8) consensus conference, in conjunction with the Enhanced Recovery after Surgery-Cardiac Surgery Society, brought together an international, multidisciplinary team of experts to review and evaluate the literature on screening, diagnosing, and managing preoperative anemia and iron deficiency in patients undergoing cardiac surgery, and to provide evidence-based recommendations in accordance with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria for evaluating biomedical literature.
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Xia T, Chen G, Zhou D, Liu W, Li X, Gu H, Ye Y, Du J, Fan J, Peng X. Nucleic Acid Probe-Based Difunctional Hematology Analysis Kit for Peripheral Blood Cell Analysis. ACS Sens 2022; 7:469-476. [PMID: 35129973 DOI: 10.1021/acssensors.1c02209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Traditional "one for one channel" long-wavelength probes in hematology analyzers limit their resolution and detection efficiency. In this study, we developed a "one for two channels" probe named NATO, which shows a short wavelength (λabs = 460 nm), good nucleus and nucleolus location, and a high signal-to-noise ratio to nucleic acids. When NATO was made into a hematology analysis kit and applied in an automated hematology analyzer, short-wavelength absorbance endows NATO with higher resolution, which in turn leads to better separation of red blood cells and platelets in the blood shadow of the differentiating (DIFF) channel. In addition, this kit showed terrific performance in both DIFF and reticulocytes channels. Our study sheds light on the development of hematology analysis in an automated hematology analyzer by proposing a nucleic acid probe with difunction and higher resolution.
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Affiliation(s)
- Tianping Xia
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian 116024, China
| | - Gengwen Chen
- Hematology Reagent R&D, Mindray Bio-medical Electronics Co. Ltd., Shenzhen 518132, China
| | - Danhong Zhou
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian 116024, China
| | - Weijian Liu
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian 116024, China
| | - Xiaojing Li
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian 116024, China
| | - Hua Gu
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian 116024, China
| | - Yi Ye
- Hematology Reagent R&D, Mindray Bio-medical Electronics Co. Ltd., Shenzhen 518132, China
| | - Jianjun Du
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian 116024, China
| | - Jiangli Fan
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian 116024, China
- Ningbo Institute of Dalian University of Technology, Ningbo 315016, China
| | - Xiaojun Peng
- State Key Laboratory of Fine Chemicals, Dalian University of Technology, Dalian 116024, China
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Borgmeier E, Lawrence H, Morton C, McEvoy MD. Perioperative anemia management. Int Anesthesiol Clin 2022; 60:1-7. [PMID: 34897216 DOI: 10.1097/aia.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Emilee Borgmeier
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Heather Lawrence
- Hi-RiSE Preoperative Optimization Clinic, Vanderbilt University Medical Center
| | - Colleen Morton
- Department of Medicine, Vanderbilt University Medical Center
| | - Matthew D McEvoy
- Vanderbilt University School of Medicine
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Adeleke I, Chae C, Okocha O, Sweitzer B. Risk assessment and risk stratification for perioperative complications and mitigation: Where should the focus be? How are we doing? Best Pract Res Clin Anaesthesiol 2021; 35:517-529. [PMID: 34801214 DOI: 10.1016/j.bpa.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/07/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023]
Abstract
Various risk stratification tools are used to predict patients' risk of adverse outcomes. Most of these tools are based on type of surgery and patient comorbidities. Accuracy of risk prediction is improved when additional factors such as functional capacity are included. However, these tools are limited because data are obtained from specific patient populations, are simplified to aid ease of use, and do not account for improved treatment modalities that occur over time. Risk estimation allows for shared decision-making among the perioperative care team and the patient, for perioperative planning, and for opportunity for risk mitigation. Technological advancement in data collection will likely improve existing risk assessment and allow development of new options. Future research should focus on establishing and standardizing perioperative outcomes that include meaningful patient-centric considerations such as quality of life. We review available stratification tools and important risk assessment biomarkers that address the most common causes of adverse outcomes.
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Affiliation(s)
- Ibukun Adeleke
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
| | - Christina Chae
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
| | - Obianuju Okocha
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
| | - BobbieJean Sweitzer
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
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Cho BC, Frank SM, Hensley NB. Showing up for cardiac surgery with enough red blood cells. Transfusion 2021; 61:2519-2521. [PMID: 34519078 DOI: 10.1111/trf.16618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 07/31/2021] [Indexed: 01/04/2023]
Affiliation(s)
- Brian C Cho
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Steven M Frank
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Nadia B Hensley
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Luan-Erfe BM, Yilmaz M, Sweitzer B. Preoperative Intravenous Iron and Erythropoietin to Treat Severe Anemia in Patient With Stage 4 Kidney Disease Before Oncologic Surgery: A Case Report. A A Pract 2020; 14:e01234. [PMID: 32496428 DOI: 10.1213/xaa.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Preoperative treatment of anemia with intravenous iron is inconsistent despite known risks of anemia and allogeneic blood transfusions. Limited research exists on the effectiveness of preoperative intravenous iron for chronic kidney disease (CKD) patients. We discuss a patient with severe anemia from advanced CKD, endometrial cancer, and menometrorrhagia. Her hemoglobin increased more than 2 g/dL after erythropoietin and two 750-mg ferric carboxymaltose infusions 5 weeks before a total abdominal hysterectomy and avoided blood transfusions perioperatively. By raising hemoglobin, preoperative intravenous iron and erythropoietin reduce blood transfusions and consequent risk of future allograft rejection and alloimmunization in potential transplant recipients.
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Affiliation(s)
- Betty M Luan-Erfe
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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