Recommendations From the International Consensus Conference on Anemia Management in Surgical Patients (ICCAMS)

BACKGROUND

Perioperative anemia has been associated with increased risk of red blood cell transfusion and increased morbidity and mortality after surgery. The optimal approach to the diagnosis and management of perioperative anemia is not fully established.

OBJECTIVE

To develop consensus recommendations for anemia management in surgical patients.

METHODS

An international expert panel reviewed the current evidence and developed recommendations using modified RAND Delphi methodology.

RESULTS

The panel recommends that all patients except those undergoing minor procedures be screened for anemia before surgery. Appropriate therapy for anemia should be guided by an accurate diagnosis of the etiology. The need to proceed with surgery in some patients with anemia is expected to persist. However, early identification and effective treatment of anemia has the potential to reduce the risks associated with surgery and improve clinical outcomes. As with preoperative anemia, postoperative anemia should be treated in the perioperative period.

CONCLUSIONS

Early identification and effective treatment of anemia has the potential to improve clinical outcomes in surgical patients.

Utility of reticulocyte haemoglobin content and immature reticulocyte fraction in early diagnosis of latent iron deficiency in whole blood donors

BACKGROUND AND OBJECTIVES

The present study was planned to assess the clinical utility of reticulocyte haemoglobin content (CHr) and immature reticulocyte fraction (IRF) in the early detection of latent iron deficiency in blood donors.

MATERIALS AND METHODS

The prospective longitudinal observational study was conducted using the purposive sampling method. Written informed consent was obtained and donors were allocated into the first-time (FTD) and regular donor (RD) group. The enrolled blood donors (n = 205 in each group) were followed up for two subsequent whole blood donations. Haemoglobin (Hb), CHr, IRF and serum ferritin values were recorded at enrolment and two follow-ups.

RESULTS

The sensitivity of CHr in detecting iron-deficient erythropoiesis (serum ferritin values ≤ 26 μg/dl) was 45% and 56.7%, specificity 96.7%, positive predictive value (PPV) 85.6% and 90.8% and negative predictive value (NPV) 80.1% and 78.7%, respectively in FTD and RD cohorts. The sensitivity of IRF was 45.1% and 44.8%, specificity 93.4% and 97.1%, PPV 74.8% and 90.4% and NPV 79.6% and 74.5%, respectively in both the cohorts. The sensitivity of CHr in detecting absent iron stores (serum ferritin values ≤ 15 μg/dl) was 66.2% and 74.4%, specificity 92% and 90.6%, PPV 56.7% and 68.7% and NPV 94.5% and 92.8% among FTD and RD cohort, respectively. The sensitivity of IRF was 72.7% and 65.3%, specificity 90.3% and 94.3%, PPV 54.4% and 76% and NPV 95.4% and 90.8%, respectively in both the cohorts.

CONCLUSION

Reticulocyte hemoglobin content and IRF can be used along with complete blood count for early detection of iron deficiency in blood donors using the same blood sample at no extra cost.

Evaluation of Iron Status by Reticulocyte Haemoglobin Content (Chr) in Chronic Kidney Disease Patients on Haemodialysis and Erythropoietin

Diagnosing iron deficiency with currently available tests is difficult in patients with chronic kidney disease (CKD) due to the inflammatory state associated with uraemia. The aim of this study was to evaluate the importance of reticulocyte haemoglobin (CHr) as a diagnostic tool of iron deficiency and a predictor to intravenous iron therapy in a cohort of CKD patients on haemodialysis in Sri Lanka. This was a descriptive cross sectional study involving hundred (100) patients with CKD on regular haemodialysis and erythropoietin. Patients were categorised into groups depending on serum ferritin, transferrin saturation and reticulocyte haemoglobin (CHr). All patients with CHr < 29 pg were treated with a single dose of intravenous(IV) iron 500 mg. The CHr was measured 72 h after the IV iron treatment to assess the response. Within the population mean haemoglobin was 9.27 g/dL, mean serum ferritin was 243.5 ng/mL, mean transferrin saturation was 18.6% and mean CHr was 29.2 pg. Thirty three of the 100 patients (33%) were subjected to IV iron therapy and there was a significant increase of CHr 72 h after IV iron treatment (p < 0.001). As a diagnostic tool in iron deficiency in CKD patients on haemodialysis, CHr showed a sensitivity of 56%, specificity of 73% and positive predictive value of 84%. Reticulocyte haemoglobin (CHr) can be used as an early predictor of response to IV iron therapy. However, further evaluation is necessary to consider CHr as a diagnostic tool to detect iron deficiency in CKD patients on haemodialysis.