SP1.1.8Optimising anaemic patients for colorectal cancer surgery: implementation of day-case iron infusion pathway and closed loop audit of anaemia management

Aims Pre-operative anaemia is associated with increased mortality and morbidity in patients undergoing colorectal cancer (CRC) surgery. NICE recommends screening for and treating anaemia in this patient group. Our local guidelines reflect this and advocate the use of pre-operative IV iron provided to patients in the day-case unit. Through 2 audit cycles we assessed whether anaemic CRC patients were prescribed pre-operative iron infusion. Secondary outcome was the requirement of post-operative blood transfusion. Methods Data was collected between June-August 2019 (cycle 1) and January-February 2020 (cycle 2) for patients undergoing elective CRC surgery. Data collected included haemoglobin levels pre and post-operatively, pre-operative iron infusion and post-operative blood transfusion rates. Between the cycles education regarding anaemia management and further publicity of the iron infusion pathway took place within the department. Results In cycle 1 27.5% (11/40) of patients were anaemic; 18% (2/11) of these patients received appropriate iron infusion pre-operatively. In cycle 2 45.4% (20/44) of patients were anaemic; 60% (12/20) received iron infusion. 45% (5/11) of anaemic patients in cycle 1 had post-operative transfusion; none of these patients had pre-operative IV iron. In cycle 2 20% (4/20) of anaemic patient required post-operative transfusion; 3 out of 4 of these patients had not received pre-operative IV iron. Conclusions We have demonstrated how education and improved awareness of local services can increase rate of IV iron prescription and reduce the need for post-operative transfusion in anaemic CRC patients. However these is still room for improvement in management of anaemia within this patient group.

521 Optimising Anaemic Patients for Colorectal Cancer Surgery: Implementation of Day-Case Iron Infusion Pathway and Closed Loop Audit of Anaemia Management in Colorectal Cancer Patients

Aim Pre-operative anaemia is associated with increased mortality and morbidity in patients undergoing colorectal cancer (CRC) surgery. NICE recommends screening for and treating anaemia in this patient group. Our local guidelines reflect this and advocate the use of pre-operative IV iron provided to patients in the day-case unit. Through 2 audit cycles we assessed whether anaemic CRC patients were prescribed pre-operative iron infusion. Secondary outcome was the requirement of post-operative blood transfusion. Method Data was collected between June-August 2019 (cycle 1) and January-February 2020 (cycle 2) for patients undergoing elective CRC surgery. Data collected included haemoglobin levels pre- and post-operatively, pre-operative iron infusion and post-operative blood transfusion rates. Between the cycle’s education regarding anaemia management and further publicity of the iron infusion pathway took place within the department. Results In cycle 1 27.5% (11/40) of patients were anaemic; 18% (2/11) of these patients received appropriate iron infusion pre-operatively. In cycle 2 45.4% (20/44) of patients were anaemic; 60% (12/20) received iron infusion. 45% (5/11) of anaemic patients in cycle 1 had post-operative transfusion; none of these patients had pre-operative IV iron. In cycle 2 20% (4/20) of anaemic patient required post-operative transfusion; 3 out of 4 of these patients had not received pre-operative IV iron. Conclusions We have demonstrated how education and improved awareness of local services can increase rate of IV iron prescription and reduce the need for post-operative transfusion in anaemic CRC patients. However, these is still room for improvement in management of anaemia within this patient group.

Portal Vein Thrombosis Secondary to Occult Polycythemia Vera

Portal vein thrombosis (PVT) is an uncommon finding in patients without cirrhosis. The underlying aetiology is challenging and the condition has a wide differential diagnosis. We present a case of PVT in an anaemic patient with chronic iron and folic acid deficiency masking underlying polycythemia vera (PV). Only a careful review of the patient’s clinical history allowed the identification of a short period of laboratory erythrocytosis, 6 months before the clinical onset of PVT, while the patient was on iron and folic acid supplementation. The finding raised clinical suspicion of PV previously masked by iron deficiency anaemia. Subsequent investigation confirmed the presence of the JAK2 V617F mutation and, ultimately, showed that the patient met all diagnostic criteria for PV. Myeloproliferative disorders (MPD) are associated with systemic prothrombotic states. PV is distinguished clinically from other MPD by the presence of increased red blood cell mass. Moreover, patients with abnormal haematocrit values in the pre-JAK2 V617F era may have had occult or latent PV. Diagnosis confirmation requires a combination of major and minor criteria to capture occasional cases of occult PV. This case emphasizes the importance of always considering MPD in the aetiological investigation of PVT, even in patients who apparently do not fulfil the diagnostic criteria.

Study on prevalence of anemia in pregnant women in labour

Background: In the developing world Nutritional deficiency anaemia is the commonest finding in pregnant women. Lack of balanced diet, poor socio-economic status, repeated pregnancies and illiteracy are seen associated with Anaemia commonly. Anaemia itself results in maternal morbidities and poor pregnancy outcomes. Neonatal morbidities also have a direct equation with anaemia. It is a study done on pregnant women in labour with the sole objective to estimate the prevalence of anaemia amongst them and associated fetomaternal morbidities.Methods: It is a prospective observational study done on 300 pregnant women presenting in labour from October 2019-Decemebr 2019, in Government Doon Medical College, Dehradun. These women belonged to Dehradun and surrounding hilly areas of Uttarakhand. Their haemoglobin levels (complete blood count) were assessed at the time of admission along with other routine investigations. They were also assessed for associated pre and post-delivery morbidities and mortality.Results: In this study, out of 300 pregnant women presenting in labour from October 2019 to December 2019, in Government Doon Medical College Dehradun, the incidence of anaemia was found to be very high (70%). Severely anaemic patient group was found to have maximum number of fetomaternal complications and blood transfusion requirements.Conclusions: Despite all the maternal welfare programmes being run at National levels, it is being observed that there is a high unacceptable prevalence of anaemia in pregnant women. This increases their morbidity and mortality. It is a huge burden on hospital finances and blood bank for blood transfusions which are preventable. There is need to strengthen our health care system at primary level for pregnant women and teenage girls.

Increased severity of anaemia is associated with 30-day complications following total joint replacement

Aims The aim of this study was to determine the impact of the severity of anaemia on postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods A retrospective cohort study was conducted using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database. All patients who underwent primary TKA or THA between January 2012 and December 2017 were identified and stratified based upon hematocrit level. In this analysis, we defined anaemia as packed cell volume (Hct) < 36% for women and < 39% for men, and further stratified anaemia as mild anaemia (Hct 33% to 36% for women, Hct 33% to 39% for men), and moderate to severe (Hct < 33% for both men and women). Univariate and multivariate analyses were used to evaluate the incidence of multiple adverse events within 30 days of arthroplasty. Results Following adjustment, patients in the THA cohort with moderate to severe anaemia had an increased odds of 6.194 (95% confidence interval (CI) 5.679 to 6.756; p < 0.001) for developing any postoperative complication. Following adjustment, patients in the TKA cohort with moderate to severe anaemia had an increased odds of 5.186 (95% CI 4.811 to 5.590; p < 0.001) for developing any postoperative complication. Among both cohorts, as severity increased, there was an increased risk of postoperative complications. Conclusion Preoperative anaemia is a risk factor for complications following primary arthroplasty. There is a significant relationship between the severity of anaemia and the odds of postoperative complications. Patients who had moderate to severe anaemia were at increased risk of developing postoperative complications relative to patients with mild anaemia. When considering elective primary THA or TKA in a moderately or severely anaemic patient, surgeons should strongly consider correcting anaemia prior to surgery if possible. Cite this article: Bone Joint J 2020;102-B(4):485–494.

Haemoglobin E Trait: A Frequently Incriminated Innocent Trait

Background: Haemoglobin (Hb) level in Hb E trait or heterozygous Hb E usually does not go bellow reference level, so does not causes any significant anaemia. However, many medical practitioner conclude Hb E trait as a cause of anaemia when they find Hb E trait in the course of evaluation.Objective:The objective of this case series is to find out whether Hb E trait can be a cause of significant anaemia or not.Methods: A series of cases of Hb E trait with significant anaemia was systematically evaluated to find out the real cause of anaemia and treated accordingly and followed up to find out whether Hb E trait itself can be a cause of anaemia at all.Result: Out of 13 anaemic patients presented with the diagnosis of Hb E trait, 1 was not Hb E tarit at all but Hb E/â thalassaemia. Out of 12 actual Hb E trait, 1 expired within treatment for acute lymphoblastic leukaemia. Correctable cause of anaemia was found in 10 out of remaining 11 cases and 1 case had very high CRP and didn’t comply with further investigation. Anaemia was corrected with treatment in 9 cases and partially corrected in 1 case who was not compliant to regular treatment.Conclusion: Hb E trait is not a cause of significant anaemia and a probable incidental finding in anaemic patient undergoing Hb electrophoresis, especially in areas where Hb E is quite common like Bangladesh.J Dhaka Medical College, Vol. 26, No.1, April, 2017, Page 32-35