Management of Perioperative Anemia in Patients that Performed Abdominal Major Surgery.
AJTES Vol 6, No 1, January 2022
Naco et al

Keywords

anemia
blood
blood plasma
iron deficiency anemia
transfusion-transmitted infections

How to Cite

Naco, M., Gani, H., Duro, V., & Naco, E. (2022). Management of Perioperative Anemia in Patients that Performed Abdominal Major Surgery. Albanian Journal of Trauma and Emergency Surgery, 6(1), 968-975. https://doi.org/10.32391/ajtes.v6i1.241

Abstract

Introduction: Anemia is a recognized predictor of adverse postoperative outcomes in patients during abdominal major surgery. The management of perioperative anemia involves many strategies. Pre-operative anemia has adverse outcomes in major surgery and is called the fourth factor. Anemia was then classified into mild, moderate, and severe depending on hemoglobin level. It is present almost in 40% of patients that performed elective major surgery. Patients with preoperative anemia are associated with an increased rate of blood transfusion together with a risk for high morbidity and mortality.  The most usual cause of preoperative anemia is iron deficiency, which can be treated with oral/intravenous iron depending on the time scheduled for surgery. A review concluded that anemia recovery earlier with preoperative intravenous iron than with oral iron supplement. A perioperative erythropoietin injection is also a reasonable approach for patients with hemoglobin between 10 and 13 g/dL and if autologous blood donation is performed.  The protocol requires a baseline complete blood count and iron studies and all patients should receive iron supplementation during erythropoietin therapy. The next strategy is stabilized macro/ microcirculation to optimize the patient´s tolerance to bleeding. Recent recommendation, in general, suggests no bridging therapy consider it only if high thrombotic risk. Finally, targeted surgery should be used to reduce intraoperative and postoperative bleeding. We recommend a restrictive transfusion strategy. Allogeneic blood transfusion is associated with an increased incidence of nosocomial infections. Postoperative anemia must be treated with the use of intravenous iron. We ought to know fresh frozen plasma used in deficit in factor V, XI, in dose 15-30ml/kg and be aware of its complications as immunomodulation, acute lung injury, and cardiac overload.

Conclusion: Our goal is to improve patients´ clinical outcomes.

https://doi.org/10.32391/ajtes.v6i1.241
Naco et al

References

World Health Organization. Nutritional Anemia: Report of a WHO Scientific Group. Geneva: WHO, 1968.

S. Lako, V. Ndreu, A Deda. Anemia ferriprive 34. https://sites.google.com/a/infermieria.info/home/home/revista

Steinbicker A, Zurheiden NJ, Buckmann A, et al. Patient blood management: Umsetzung im Rahmen der Anaesthesiesprechstunde.Anaesth Intensivmed 2015; 56:64–74.

J. Partridge, D. Harari, J. Gossage, J. Dhesi. Anaemia in the older surgical patient: a review of prevalence, causes, implications and management. R Soc Med 2013: 106: 269–277. DOI: 10.1177/0141076813479580.

Sibylle A. Kozek-Langenecker, Aamer B. Ahmed, Arash Afshari& al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology Eur J Anaesthesiol 2017; 34:332–395.

Froessler B, Palm P, Weber I, & al. The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Annals of Surgery 2016; 264: 41–6.

Akshay A. Shah, MSc; Killian Donovan, BM, BCh; Claire Seeley, & al. Risk of Infection Associated with Administration of Intravenous Iron A Systematic Review and Meta-analysis. JAMA Network Open. 2021;4(11): e2133935. doi:10.1001/jamanetworkopen.2021.33935.

WHO. Iron Deficiency Anaemia: Assessment, Prevention, and Control. A Guide for Programme Managers. Geneva: WHO, 2001.

Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low- and middle-income countries. Blood 2013; 121: 2607–17.

Peyrin-Biroulet L, Williet N, Cacoub P. Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. American Journal of Clinical Nutrition 2015; 102: 1585–94

Schiergens TS, Rentsch M, Kasparek MS, et al. Impact of perioperative allogeneic red blood cell transfusion on recurrence and overall survival after resection of colorectal liver metastases. Dis Colon Rectum 2015; 58:74–82.

Theusinger OM, Kind SL, Seifert B, et al. Patient blood management in orthopaedic surgery: a four-year follow-up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich, Switzerland. Blood Transfus 2014; 12:195–203.

Kotze A, Carter LA, Scally AJ. Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Br J Anaesth 2012; 108: 943–52.

K. E. Munting,A. A. Klein Optimisation of pre-operative anaemia in patients before elective major surgery – why, who, when and how? https://doi.org/10.1111/anae.14466 First published: 02 January 2019 Anaesthesia 2019, 74 (Suppl. 1), 49–57.

Wilson MJ, van Haaren M, Harlaar JJ, et al. Long-term prognostic value of preoperative anemia in patients with colorectal cancer: a systematic review and meta-analysis.

Surgical Oncology 2017; 26: 96–104.

Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Annals of Surgery 2012; 256: 235–44.

Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database of Cochrane Database of Systematic Reviews 2006; 1: CD005033.

National Institute for Health and Clinical Excellence. Blood transfusion. Quality standard [QS138]. 2016. https://www.nice.org.uk/guidance/qs138 (accessed 22/03/2018)

Iron deficiency anemia: assessment, prevention and control. A guide for programme managers. 2001. http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/WHO_NHD_01.3 /en/ (accessed 22/03/2018).

Shander A, Knight K, Thurer R, & al.Prevalence and outcomes of anemia in surgery: a systematic review of the literature. The American Journal of Medicine 2004; 116(Suppl 7A): 58S–69S.

Goodnough LT, Maniatis A, Earnshaw P, et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. British Journal of Anaesthesia 2011; 106: 13–22.

Akshay A. Shah, MSc; Killian Donovan, BM, BCh; Claire Seeley, M & al.Risk of Infection Associated With Administration of Intravenous Iron A Systematic Review and Meta-analysis JAMA Network Open. 2021;4(11): e2133935. doi:10.1001/jamanetworkopen.2021.33935

E. Bisbe, L. Molto, R. Arroyo, J.& al. Randomized trial comparing ferric carboxymaltose vs oral ferrous glycine sulphate for postoperative anaemia after total knee arthroplasty. British Journal of Anaesthesia 113 (3): 402–9 (2014) Advance Access publication 29 April 2014. doi:10.1093/bja/a.u092

C.O. Ramos-Pe˜nafiel∗, C. Balderas-Delgado, Á. Cabrera-García. Surgery and transfusion Rev Med Hosp Gen Méx. 2016;79(2):98-106.

Shander A, Javidroozi M, Perelman S, et al. From blood-less surgery to patient blood management. Mt Sinai J Med.2012; 79:56-65.

Shander A, Spence RK, Auerbach M. Can intravenous irontherapy meet the unmet needs created by the new restric-tions on erythropoietic stimulating agents? Transfusion (Paris).2010;50:719-32.

De Robertis E, Longrois D. To streamline the guideline challenge: The European Society of Anaesthesiology policy on guidelines development.Eur J Anaesthesiol 2016; 33:794–799.

N. M. Calle, F. H. Martínez Ana Alfonso Pierola. Implementation of a management protocol for massive bleeding reduces mortality in non-trauma patients: Results from a single centre audit .July 2016, Medicina Intensiva 40(9) DOI:10.1016/j.medin.2016.05.003

Gilliss BM, Looney MR, Gropper MA. Reducing noninfectious risks of blood transfusion. Anesthesiology 2011; 115:635–649.

Edgeworth JA, Farmer M, Sicilia A, et al. Detection of prion infection invariant Creutzfeldt-Jakob disease: a blood-based assay. Lancet 2011; 377:487–493.

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