Optimisation of pre-operative anaemia in patients before elective major surgery – why, who, when and how?

Anaesthesia

Volumn 74, Issue , 2019, Pages 49-57

  Munting, K E ^a   Klein, A A ^b  

^a UNIVERSITY MEDICAL CENTER UTRECHT   (Netherlands)

^b PAPWORTH HOSPITAL   (United Kingdom)

Author keywords

anaemia; pre operative; transfusion; treatment

Indexed keywords

ANEMIA; CANCER SURGERY; ELECTIVE SURGERY; HEART SURGERY; HUMAN; MAJOR SURGERY; OBSTETRIC OPERATION; ORTHOPEDIC SURGERY; PREOPERATIVE COMPLICATION; REVIEW; PREOPERATIVE CARE; PROCEDURES;

IRON;

ANEMIA; ELECTIVE SURGICAL PROCEDURES; HUMANS; IRON; PREOPERATIVE CARE;

EID: 85059487261     PISSN: 00032409     EISSN: 13652044     Source Type: Journal    
DOI: 10.1111/anae.14466     Document Type: Review

References (91)

1. World Health Organization. Availability, safety and quality of blood products. 2010. http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R12-en.pdf (accessed 22/03/2018).
2. National Institute for Health and Clinical Excellence. Blood transfusion. NICE guideline [NG24]. 2015. https://www.nice.org.uk/guidance/ng24. (accessed 22/03/2018).
3. Kozek-Langenecker SA, Ahmed AB, Afshari A, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016. European Journal of Anaesthesiology 2017; 34: 332–95.
4. Society for the Advancement of Blood Management. SABM executive guide for patient blood management programs. 2016. https://www.sabm.org/publications (accessed 22/03/2018).
5. Munoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia 2017; 72: 233–47.
6. Meybohm P, Froessler B, Goodnough LT, et al. Simplified international recommendations for the implementation of patient blood management (SIR4PBM). Perioperative Medicine 2017; 6: 5,017-0061-8.
7. Klein AA, Bailey CR, Charlton AJ, et al. Association of Anaesthetists guidelines: cell salvage for peri?operative blood conservation. Anaesthesia 2018; 73: 1141–50.
8. Loftus TJ, Spratling L, Stone BA, Xiao L, Jacofsky DJ. A patient blood management program in prosthetic joint arthroplasty decreases blood use and improves outcomes. Journal of Arthroplasty 2016; 31: 11–14.
9. 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. British Journal of Anaesthesia 2012; 108: 943–52.
10. Rineau E, Chaudet A, Chassier C, Bizot P, Lasocki S. Implementing a blood management protocol during the entire perioperative period allows a reduction in transfusion rate in major orthopedic surgery: a before-after study. Transfusion 2016; 56: 673–81.
11. Gross I, Seifert B, Hofmann A, Spahn DR. Patient blood management in cardiac surgery results in fewer transfusions and better outcome. Transfusion 2015; 55: 1075–81.
12. Meybohm P, Herrmann E, Steinbicker AU, et al. Patient blood management is associated with a substantial reduction of red blood cell utilization and safe for patient's outcome: a prospective, multicenter cohort study with a noninferiority design. Annals of Surgery 2016; 264: 203–11.
13. Leahy MF, Hofmann A, Towler S, et al. Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion 2017; 57: 1347–58.
14. Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 2011; 378: 1396–407.
15. Baron DM, Hochrieser H, Posch M, et al. Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. British Journal of Anaesthesia 2014; 113: 416–23.
16. Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. British Journal of Surgery 2015; 102: 1314–24.
17. Klein AA, Collier TJ, Brar MS, et al. The incidence and importance of anaemia in patients undergoing cardiac surgery in the UK – the first Association of Cardiothoracic Anaesthetists national audit. Anaesthesia 2016; 71: 627–35.
18. Ferraris VA, Davenport DL, Saha SP, Austin PC, Zwischenberger JB. Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Archives of Surgery 2012; 147: 49–55.
19. Munoz M, Gomez-Ramirez S, Campos A, Ruiz J, Liumbruno GM. Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfusion 2015; 13: 370–9.
20. Chau M, Richards T, Evans C, Butcher A, Collier T, Klein A. The UK Cardiac and Vascular Surgery Interventional Anaemia Response (CAVIAR) Study: protocol for an observational cohort study to determine the impact and effect of preoperative anaemia management in cardiac and vascular surgical patients. British Medical Journal Open 2017; 7: e014872.
21. Intravenous iron for treatment of anaemia before cardiac surgery (ITACS). 2015. https://clinicaltrials.gov/ct2/show/record/NCT02632760?term=ITACS&rank=1 (accessed 22/03/2018).
22. Impact of preoperative treatment of anemia and iron deficiency in cardiac surgery on outcome. 2014. https://www.clinicaltrials.gov/ct2/show/study/NCT02031289?term=anaemia&type=Intr&cond=surgery&intr=iron&age=12&rank=2&view=record (accessed 22/03/2018).
23. Trial comparing Ferric(III)Carboxymaltose infusion with oral iron suppletion as treatment of anaemia (FIT). 2014. https://www.clinicaltrials.gov/ct2/show/NCT02243735?term=iron&type=Intr&cond=surgery&intr=iron&age=12&rank=16 (accessed 22/03/2018).
24. Richards T, Clevenger B, Keidan J, et al. PREVENTT: preoperative intravenous iron to treat anaemia in major surgery: study protocol for a randomised controlled trial. Trials 2015; 16: 254,015-0774-2.
25. Iron deficiency anaemia: 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).
26. Shander A, Knight K, Thurer R, Adamson J, Spence R. Prevalence and outcomes of anemia in surgery: a systematic review of the literature. The American Journal of Medicine 2004; 116(Suppl 7A): 58S–69S.
27. Munoz M, Laso-Morales MJ, Gomez-Ramirez S, Cadellas M, Nunez-Matas MJ, Garcia-Erce JA. Pre-operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery. Anaesthesia 2017; 72: 826–34.
28. Gurusamy KS, Nagendran M, Broadhurst JF, Anker SD, Richards T. Iron therapy in anaemic adults without chronic kidney disease. Cochrane Database of Systematic Reviews 2014; 12: CD010640.
29. Madi-Jebara SN, Sleilaty GS, Achouh PE, et al. Postoperative intravenous iron used alone or in combination with low-dose erythropoietin is not effective for correction of anemia after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2004; 18: 59–63.
30. Edwards TJ, Noble EJ, Durran A, Mellor N, Hosie KB. Randomized clinical trial of preoperative intravenous iron sucrose to reduce blood transfusion in anaemic patients after colorectal cancer surgery. British Journal of Surgery 2009; 96: 1122–8.
31. Serrano-Trenas JA, Ugalde PF, Cabello LM, Chofles LC, Lazaro PS, Benitez PC. Role of perioperative intravenous iron therapy in elderly hip fracture patients: a single-center randomized controlled trial. Transfusion 2011; 51: 97–104.
32. Garrido-Martin P, Nassar-Mansur MI, de la Llana-Ducros R, et al. The effect of intravenous and oral iron administration on perioperative anaemia and transfusion requirements in patients undergoing elective cardiac surgery: a randomized clinical trial. Interactive Cardiovascular Thoracic Surgery 2012; 15: 1013–18.
33. Karkouti K, McCluskey SA, Ghannam M, et al. Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia. Canadian Journal of Anaesthesia 2006; 53: 11–19.
34. Lidder PG, Sanders G, Whitehead E, et al. Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery - a prospective, randomised, controlled trial. Annals of the Royal College of Surgeons of England 2007; 89: 418–21.
35. Bisbe E, Molto L, Arroyo R, Muniesa JM, Tejero M. Randomized trial comparing ferric carboxymaltose vs. oral ferrous glycine sulphate for postoperative anaemia after total knee arthroplasty. British Journal of Anaesthesia 2014; 113: 402–9.
36. Peters F, Ellermann I, Steinbicker AU. Intravenous iron for treatment of anemia in the 3 perisurgical phases: a review and analysis of the current literature. Anesthesia and Analgesia 2018; 126: 1268–82.
37. Wilson MJ, Dekker JW, Bruns E, et al. Short-term effect of preoperative intravenous iron therapy in colorectal cancer patients with anemia: results of a cohort study. Transfusion 2018; 58: 795–803.
38. Heschl M, Gombotz H, Haslinger-Eisterer B, Hofmann A, Bohler N, Meier J. The efficacy of pre-operative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: an observational study. European Journal of Anaesthesiology 2018; 35: 289–97.
39. Kearney B, To J, Southam K, Howie D, To B. Anaemia in elective orthopaedic surgery – Royal Adelaide Hospital, Australia. Internal Medicine Journal 2016; 46: 96–101.
40. World Health Organization. Nutritional anaemias. 1968. http://apps.who.int/iris/bitstream/handle/10665/40707/WHO_TRS_405.pdf?sequence=1. (accessed 22/03/2018).
41. Butcher A, Richards T, Stanworth SJ, Klein AA. Diagnostic criteria for pre-operative anaemia-time to end sex discrimination. Anaesthesia 2017; 72: 811–14.
42. Gombotz H, Rehak PH, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark study. Transfusion 2007; 47: 1468–80.
43. Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic surgery transfusion hemoglobin european overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 2003; 43: 459–69.
44. Blaudszun G, Munting KE, Butchart A, Gerrard C, Klein AA. The association between borderline pre-operative anaemia in women and outcomes after cardiac surgery: a cohort study. Anaesthesia 2018; 73: 572–8.
45. Munoz M, Gomez-Ramirez S, Kozek-Langeneker S, et al. ‘Fit to fly’: overcoming barriers to preoperative haemoglobin optimization in surgical patients. British Journal of Anaesthesia 2015; 115: 15–24.
46. Ludwig H, Van Belle S, Barrett-Lee P, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. European Journal of Cancer 2004; 40: 2293–306.
47. Birgegard G, Aapro MS, Bokemeyer C, et al. Cancer-related anemia: pathogenesis, prevalence and treatment. Oncology 2005; 68(Suppl 1): 3–11.
48. Caro JJ, Salas M, Ward A, Goss G. Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer 2001; 91: 2214–21.
49. Knight K, Wade S, Balducci L. Prevalence and outcomes of anemia in cancer: a systematic review of the literature. The American Journal of Medicine 2004; 116(Suppl 7A): 11S–26S.
50. Cata JP, Lasala J, Pratt G, Feng L, Shah JB. Association between perioperative blood transfusions and clinical outcomes in patients undergoing bladder cancer surgery: a systematic review and meta-analysis study. Journal of Blood Transfusion 2016; 2016: 9876394.
51. Li SL, Ye Y, Yuan XH. Association between allogeneic or autologous blood transfusion and survival in patients after radical prostatectomy: a systematic review and meta-analysis. PLoS ONE 2017; 12: e0171081.
52. 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.
53. Agnes A, Lirosi MC, Panunzi S, Santocchi P, Persiani R, D'Ugo D. The prognostic role of perioperative allogeneic blood transfusions in gastric cancer patients undergoing curative resection: a systematic review and meta-analysis of non-randomized, adjusted studies. European Journal of Surgical Oncology 2018; 44: 404–19.
54. Liu L, Wang Z, Jiang S, et al. Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PLoS ONE 2013; 8: e64261.
55. Lyu X, Qiao W, Li D, Leng Y. Impact of perioperative blood transfusion on clinical outcomes in patients with colorectal liver metastasis after hepatectomy: a meta-analysis. Oncotarget 2017; 8: 41740–8.
56. Mavros MN, Xu L, Maqsood H, et al. Perioperative blood transfusion and the prognosis of pancreatic cancer surgery: systematic review and meta-analysis. Annals of Surgical Oncology 2015; 22: 4382–91.
57. Weiss G, Goodnough LT. Anemia of chronic disease. New England Journal of Medicine 2005; 352: 1011–23.
58. Harrison L, Blackwell K. Hypoxia and anemia: factors in decreased sensitivity to radiation therapy and chemotherapy? The Oncologist 2004; 9(Suppl 5): 31–40.
59. Prosnitz RG, Yao B, Farrell CL, Clough R, Brizel DM. Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer. International Journal of Radiation Oncology, Biology, Physics 2005; 61: 1087–95.
60. Vaupel P, Mayer A. Hypoxia and anemia: effects on tumor biology and treatment resistance. Transfusion Clinique et Biologique 2005; 12: 5–10.
61. 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.
62. Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database of Systematic Reviews 2006; 1: CD005033.
63. Laso-Morales M, Jerico C, Gomez-Ramirez S, et al. Preoperative management of colorectal cancer-induced iron deficiency anemia in clinical practice: data from a large observational cohort. Transfusion 2017; 57: 3040–8.
64. Cybulska P, Goss C, Tew WP, Parmeswaran R, Sonoda Y. Indications for and complications of transfusion and the management of gynecologic malignancies. Gynecologic Oncology 2017; 146: 416–26.
65. Athibovonsuk P, Manchana T, Sirisabya N. Prevention of blood transfusion with intravenous iron in gynecologic cancer patients receiving platinum-based chemotherapy. Gynecologic Oncology 2013; 131: 679–82.
66. Dangsuwan P, Manchana T. Blood transfusion reduction with intravenous iron in gynecologic cancer patients receiving chemotherapy. Gynecologic Oncology 2010; 116: 522–5.
67. Kim YT, Kim SW, Yoon BS, et al. Effect of intravenously administered iron sucrose on the prevention of anemia in the cervical cancer patients treated with concurrent chemoradiotherapy. Gynecologic Oncology 2007; 105: 199–204.
68. 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.
69. Bisbe E, Basora M, Colomina MJ, et al. Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain. Blood Transfusion 2017; 15: 296–306.
70. Walsh TS, Palmer J, Watson D, et al. Multicentre cohort study of red blood cell use for revision hip arthroplasty and factors associated with greater risk of allogeneic blood transfusion. British Journal of Anaesthesia 2012; 108: 63–71.
71. Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology 2010; 113: 482–95.
72. Karkouti K, Wijeysundera DN, Beattie WS, et al. Risk associated with preoperative anemia in cardiac surgery: a multicenter cohort study. Circulation 2008; 117: 478–84.
73. Miceli A, Romeo F, Glauber M, de SP, Caputo M, Angelini GD. Preoperative anemia increases mortality and postoperative morbidity after cardiac surgery. Journal of Cardiothoracic Surgery 2014; 9: 137,8090-9-137.
74. Ranucci M, Di Dedda U, Castelvecchio S, et al. Impact of preoperative anemia on outcome in adult cardiac surgery: a propensity-matched analysis. The Annals of Thoracic Surgery 2012; 94: 1134–41.
75. Hung M, Besser M, Sharples LD, Nair SK, Klein AA. The prevalence and association with transfusion, intensive care unit stay and mortality of pre-operative anaemia in a cohort of cardiac surgery patients. Anaesthesia 2011; 66: 812–18.
76. Karkouti K, Grocott HP, Hall R, et al. Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study. Canadian Journal of Anaesthesia 2015; 62: 377–84.
77. Johansson PI, Rasmussen AS, Thomsen LL. Intravenous iron isomaltoside 1000 (Monofer(R)) reduces postoperative anaemia in preoperatively non-anaemic patients undergoing elective or subacute coronary artery bypass graft, valve replacement or a combination thereof: a randomized double-blind placebo-controlled clinical trial (the PROTECT trial). Vox Sanguinis 2015; 109: 257–66.
78. Sun D, McLeod A, Gandhi S, Malinowski AK, Shehata N. Anemia in pregnancy: a pragmatic approach. Obstetrical and Gynecological Survey 2017; 72: 730–7.
79. Pavord S, Myers B, Robinson S, et al. UK guidelines on the management of iron deficiency in pregnancy. British Journal of Haematology 2012; 156: 588–600.
80. National Institute for Health and Clinical Excellence. Blood transfusion. Quality standard [QS138]. 2016. https://www.nice.org.uk/guidance/qs138 (accessed 22/03/2018).
81. NHS Blood and Transplant. National comparative audit of blood transfusion. 2016. http://hospital.blood.co.uk/audits/national-comparative-audit/surgical-audits/patient-blood-management-in-adults-undergoing-elective-scheduled-surgery-2016/ (accessed 22/03/2018).
82. Guinn NR, Guercio JR, Hopkins TJ, et al. How do we develop and implement a preoperative anemia clinic designed to improve perioperative outcomes and reduce cost? Transfusion 2016; 56: 297–303.
83. Butcher A, Richards T. Cornerstones of patient blood management in surgery. Transfusion Medicine 2017; 28: 150–7.
84. Clevenger B, Gurusamy K, Klein AA, Murphy GJ, Anker SD, Richards T. Systematic review and meta-analysis of iron therapy in anaemic adults without chronic kidney disease: updated and abridged Cochrane review. European Journal of Heart Failure 2016; 18: 774–85.
85. Froessler B, Palm P, Weber I, Hodyl NA, Singh R, Murphy EM. 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.
86. Desai N, Schofield N, Richards T. Perioperative patient blood management to improve outcomes. Anesthesia and Analgesia 2017; https://doi.org/10.1213/ANE.0000000000002549
87. Avni T, Bieber A, Grossman A, Green H, Leibovici L, Gafter-Gvili A. The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clinic Proceedings 2015; 90: 12–23.
88. Auerbach M, Adamson J, Bircher A, et al. On the safety of intravenous iron, evidence trumps conjecture. Haematologica 2015; 100: e214–15.
89. European Medicines Agency. Assessment report for: Iron containing intravenous (IV) medicinal products. 2013. http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/IV_iron_31/WC500150771.pdf; (accessed 22/03/2018).
90. Unger EF, Thompson AM, Blank MJ, Temple R. Erythropoiesis-stimulating agents–time for a reevaluation. New England Journal of Medicine 2010; 362: 189–92.
91. Klein AA, Bailey CR, Charlton A, et al. Association of Anaesthetists: anaesthesia and peri-operative care for Jehovah's Witnesses and patients who refuse blood. Anaesthesia 2018. https://doi.org/10.1111/anae.14441