Perioperative anemia management

AbstractAnemia is increasingly recognized as an interventional hematological target in patients before major surgery. Preoperative anemia increases the need for perioperative blood transfusion, and there is now a well-recognized association with increased patient complications, length of hospital stay, and worse outcomes. Patient Blood Management (PBM) is a World Health Organization endorsed, evidence-based management bundle of care in transfusion hemostasis that focuses on three main aspects: anemia management, prevention of blood loss, and appropriate transfusion practice. Implementation of PBM guidelines has been accompanied by reduced transfusion needs and improved patient outcomes. In a patient presenting with preoperative anemia or at risk of transfusion, this should initiate a program of PBM that manages the patient through the entire operative period. We review the current evidence on the three pillars of PBM and highlight those aspects with the strongest evidence in support of their impact.

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Perioperative Anemia Management as Part of PBM in Cardiac Surgery – A Narrative Updated Review

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2019.06.047 ◽

2020 ◽

Vol 34 (4) ◽

pp. 1060-1073 ◽

Cited By ~ 4

Author(s):

Patrick Meybohm ◽

Sabine Westphal ◽

Hanne Berg Ravn ◽

Marco Ranucci ◽

Seema Agarwal ◽

...

Keyword(s):

Cardiac Surgery ◽

Anemia Management ◽

Perioperative Anemia

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Perioperative anemia management in colorectal cancer patients: A pragmatic approach

World Journal of Gastroenterology ◽

10.3748/wjg.v20.i8.1972 ◽

2014 ◽

Vol 20 (8) ◽

pp. 1972 ◽

Cited By ~ 48

Author(s):

Manuel Muñoz

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Pragmatic Approach ◽

Anemia Management ◽

Colorectal Cancer Patients ◽

Perioperative Anemia

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Erythropoietin And/Or Iron Sucrose For Perioperative Anemia Management In Hip and Knee Arthroplasty

Case Medical Research ◽

10.31525/ct1-nct03917394 ◽

2019 ◽

Author(s):

Keyword(s):

Knee Arthroplasty ◽

Iron Sucrose ◽

Hip And Knee Arthroplasty ◽

Anemia Management ◽

Perioperative Anemia

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Risk Factors for Cardiovascular Disease in Patients Undergoing Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080702702s35 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 205-209 ◽

Cited By ~ 3

Author(s):

Elvia García–López ◽

Juan J. Carrero ◽

Mohamed E. Suliman ◽

Bengt Lindholm ◽

Peter Stenvinkel

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Cardiovascular Risk ◽

Pressure Control ◽

High Cardiovascular Risk ◽

Cardiovascular Research ◽

Factors Associated ◽

Glycation End Products ◽

Anemia Management ◽

Altered Lipid

Patients on peritoneal dialysis (PD) are at high cardiovascular risk. Although some risk factors are unmodifiable (for example, age, sex, genetics), others are exacerbated in the unfriendly uremic milieu (inflammation, oxidative stress, mineral disturbances) or contribute per se to kidney disease and cardiovascular progression (diabetes mellitus, hypertension). Moreover, several factors associated with PD therapy may both increase (by altered lipid profile, hyperinsulinemia, and formation of advanced glycation end-products) and decrease (by better blood pressure control and anemia management) cardiovascular risk. The present review discusses recent findings and therapy trends in cardiovascular research on the PD population, with emphasis on the roles of inflammation, insulin resistance, homocysteinemia, dyslipidemia, vascular calcification, and genetics/epigenetics.

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An Update on the Controversies in Anemia Management in Chronic Kidney Disease: Lessons Learned and Lost

Anemia ◽

10.1155/2011/623673 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Geoffrey Teehan ◽

Robert L. Benz

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Randomized Trials ◽

Lessons Learned ◽

Patients With Diabetes ◽

Anemia Management ◽

Erythropoietin Deficiency ◽

Stage Renal Disease ◽

End Stage

Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial.Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT.Results. CHOIR (N=1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03–1.74,P=.03). CREATE (N=603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38–2.68;P<.001) in TREAT (N=4038).Conclusions. There is no benefit to an Hb outside the 10–12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.

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