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

Journal of Cardiothoracic and Vascular Anesthesia

Volumn 34, Issue 4, 2020, Pages 1060-1073

  Meybohm, Patrick ^a   Westphal, Sabine ^a   Ravn, Hanne Berg ^b   Ranucci, Marco ^c   Agarwal, Seema ^d   Choorapoikayil, Suma ^a   Spahn, Donat R ^e   Ahmed, Aamer B ^f   Froessler, Bernd ^g   Zacharowski, Kai ^a  

^a UNIVERSITY HOSPITAL FRANKFURT   (Germany)

^b University of Copenhagen   (Denmark)

^c IRCCS POLICLINICO SAN DONATO   (Italy)

^d MANCHESTER UNIVERSITY NHS FOUNDATION TRUST   (United Kingdom)

^e UNIVERSITY HOSPITAL ZURICH   (Switzerland)

^f GLENFIELD HOSPITAL   (United Kingdom)

^g UNIVERSITY OF ADELAIDE   (Australia)

Author keywords

anemia; cardiac surgery; ferritin; iron supplementation; Patient Blood Management

Indexed keywords

ANTIANEMIC AGENT; CYANOCOBALAMIN; FOLIC ACID; IRON;

ANEMIA; BLOOD AUTOTRANSFUSION; BLOOD DONOR; BLOOD TRANSFUSION; GERMANY; HEALTH CARE FACILITY; HEART SURGERY; HEMATOLOGICAL PROCEDURE; HEMODILUTION; HOSPITAL; HUMAN; IRON THERAPY; MINIMALLY INVASIVE SURGERY; MULTIDISCIPLINARY TEAM; OFF PUMP SURGERY; PATIENT BLOOD MANAGEMENT; PERIOPERATIVE PERIOD; PEROPERATIVE CARE; POSTOPERATIVE CARE; PREOPERATIVE CARE; PREOPERATIVE COMPLICATION; PRIORITY JOURNAL; PROPHYLAXIS; REVIEW; SURGICAL RISK; SURGICAL TECHNIQUE; WORK EXPERIENCE; WORLD HEALTH ORGANIZATION; ADVERSE EVENT; BLEEDING; ERYTHROCYTE TRANSFUSION;

ANEMIA; BLOOD TRANSFUSION; CARDIAC SURGICAL PROCEDURES; ERYTHROCYTE TRANSFUSION; HEMORRHAGE; HUMANS;

EID: 85081142316     PISSN: 10530770     EISSN: 15328422     Source Type: Journal    
DOI: 10.1053/j.jvca.2019.06.047     Document Type: Review

References (176)

1. Society for the Advanvcement of Blood Management (SABM). Available at: http://www.sabm.org. Accessed 4 June 2015.
2. Spahn, DR, Goodnough, LT, Alternatives to blood transfusion. Lancet 381 (2013), 1855–1865.
3. Spahn, DR, Moch, H, Hofmann, A, et al. Patient blood management. The pragmatic solution for the problems with blood transfusions. Anesthesiology 109 (2008), 951–953.
4. Society for the Advancement of Blood Management (SABM). SABM Administrative and Clinical Standards for Patient Blood Management Programs. Available at: https://www.sabm.org/publications-adminstandards. Accessed 9 September 2016.
5. AABB. AABB and The Joint Commission to Partner on Patient Blood Management Certification. Available at: http://www.aabb.org/press/Pages/pr151203a.aspx. Accessed 9 September 2016.
6. AABB. Standards for a Patient Blood Management Program, 1st ed. Bethesda, Maryland: American Association of Blood Banks (AABB), 2014; ISBN-13: 978-1563958892.
7. National Blood Authority Australia. National Patient Blood Management Guidelines Implementation Strategy 2013-2017. Available at: https://blood.gov.au/system/files/documents/pbm-guidelines-implementation-strategy-november.pdf. Accessed 20 April 2015.
8. National Blood Authority Australia. Patient blood management guidelines. Available at: https://www.nba.gov.au/patient-blood-management-pbm. Accessed 9 September 2016.
9. NHS Blood and Transplant. Patient Blood Management. Available at: http://hospital.blood.co.uk/patient-services/patient-blood-management/. Accessed 9 September 2016.
10. Kozek-Langenecker S, Bettelheim P, Giurea A, et al. Interdisciplinary recommendations for the management of anaemia (Patient Blood Management). Available at: http://www.oegari.at/web_files/dateiarchiv/editor/interdisciplinary_recommendations_for_the_management_of_anaemia_2013.pdf. Accessed 6 September 2016.
11. Boer, C, Meesters, MI, Milojevic, M, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth 32 (2018), 88–120.
12. Hogan, M, Klein, AA, Richards, T, The impact of anaemia and intravenous iron replacement therapy on outcomes in cardiac surgery. Eur J Cardiothorac Surg 47 (2015), 218–226.
13. Blaudszun, G, Butchart, A, Klein, AA, Blood conservation in cardiac surgery. Transfus Med 28 (2018), 168–180.
14. 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 12 (2014), 195–203.
15. Oliver, JC, Griffin, RL, Hannon, T, et al. The success of our patient blood management program depended on an institution-wide change in transfusion practices. Transfusion 54 (2014), 2617–2624.
16. Roubinian, NH, Escobar, GJ, Liu, V, et al. Trends in red blood cell transfusion and 30-day mortality among hospitalized patients. Transfusion 54 (2014), 2678–2686.
17. Leahy, MF, Roberts, H, Mukhtar, SA, et al. A pragmatic approach to embedding patient blood management in a tertiary hospital. Transfusion 54 (2014), 1133–1145.
18. Goodnough, LT, Shieh, L, Hadhazy, E, et al. Improved blood utilization using real-time clinical decision support. Transfusion 54 (2014), 1358–1365.
19. Gross, I, Seifert, B, Hofmann, A, et al. Patient blood management in cardiac surgery results in fewer transfusions and better outcome. Transfusion 55 (2015), 1075–1081.
20. Moskowitz, DM, McCullough, JN, Shander, A, et al. The impact of blood conservation on outcomes in cardiac surgery. Is it safe and effective?. Ann Thorac Surg 90 (2010), 451–458.
21. Goodnough, LT, Maggio, P, Hadhazy, E, et al. Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion 54 (2014), 2753–2759.
22. 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 57 (2017), 1347–1358.
23. Hönemann, C, Bierbaum, M, Heidler, J, et al. Kosten der Verabreichung von Blutkonserven im Krankenhaus. Chirurg 84 (2013), 426–432.
24. Froessler, B, Rueger, AM, Connolly, MP, Assessing the costs and benefits of perioperative iron deficiency anemia management with ferric carboxymaltose in Germany. Risk Manag Healthc Policy 11 (2018), 77–82.
25. Trentino, KM, Farmer, SL, Swain, SG, et al. Increased hospital costs associated with red blood cell transfusion. Transfusion 55 (2015), 1082–1089.
26. Mehra, T, Seifert, B, Bravo-Reiter, S, et al. Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs. Transfusion 55 (2015), 2807–2815.
27. Vamvakas, EC, Reasons for moving toward a patient-centric paradigm of clinical transfusion medicine practice. Transfusion 53 (2013), 888–901.
28. Fischer, DP, Zacharowski, KD, Müller, MM, et al. Patient blood management implementation strategies and their effect on physicians' risk perception, clinical knowledge and perioperative practice - the Frankfurt experience. Transfus Med Hemother 42 (2015), 91–97.
29. National Institute for Health and Care Excellence (NICE). Quality statement 1: Iron supplementation. Available at: https://www.nice.org.uk/guidance/qs138/chapter/quality-statement-1-iron-supplementation. Accessed 18 March 2017.
30. Meybohm, P, Richards, T, Isbister, J, et al. Patient Blood management bundles to facilitate implementation. Transfus Med Rev 31 (2017), 62–71.
31. Tinegate, H, Pendry, K, Murphy, M, et al. Where do all the red blood cells (RBCs) go? Results of a survey of RBC use in England and North Wales in 2014. Transfusion 56 (2016), 139–145.
32. Arias-Morales, CE, Stoicea, N, Gonzalez-Zacarias, AA, et al. Revisiting blood transfusion and predictors of outcome in cardiac surgery patients. A concise perspective. F1000Res, 6, 2017.
33. Robich, MP, Koch, CG, Johnston, DR, et al. Trends in blood utilization in United States cardiac surgical patients. Transfusion 55 (2015), 805–814.
34. Geissler, RG, Rotering, H, Buddendick, H, et al. Utilisation of blood components in cardiac surgery. A single-centre retrospective analysis with regard to diagnosis-related procedures. Transfus Med Hemother 42 (2015), 75–82.
35. Muñoz, M, Gómez-Ramírez, S, Campos, A, et al. Pre-operative anaemia. Prevalence, consequences and approaches to management. Blood Transfus 13 (2015), 370–379.
36. Loor, G, Rajeswaran, J, Li, L, et al. The least of 3 evils. Exposure to red blood cell transfusion, anemia, or both?. J Thorac Cardiovasc Surg, 146, 2013 1480-7.e6.
37. Heymann, C von, Kaufner, L, Sander, M, et al. Does the severity of preoperative anemia or blood transfusion have a stronger impact on long-term survival after cardiac surgery?. J Thorac Cardiovasc Surg 152 (2016), 1412–1420.
38. Kulier, A, Levin, J, Moser, R, et al. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 116 (2007), 471–479.
39. Shander, A, Goodnough, LT, Javidroozi, M, et al. Iron deficiency anemia–bridging the knowledge and practice gap. Transfus Med Rev 28 (2014), 156–166.
40. Cladellas, M, Bruguera, J, Comín, J, et al. Is pre-operative anaemia a risk marker for in-hospital mortality and morbidity after valve replacement?. Eur Heart J 27 (2006), 1093–1099.
41. Karkouti, K, Wijeysundera, DN, Beattie, WS, Risk associated with preoperative anemia in cardiac surgery. A multicenter cohort study. Circulation 117 (2008), 478–484.
42. de, Santo L, G, Romano, Della Corte, A, et al. Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury. J Thorac Cardiovasc Surg 138 (2009), 965–970.
43. van Straten, AHM, Hamad, MAS, van Zundert, AJ, et al. Preoperative hemoglobin level as a predictor of survival after coronary artery bypass grafting. A comparison with the matched general population. Circulation 120 (2009), 118–125.
44. Carrascal, Y, Maroto, L, Rey, J, et al. Impact of preoperative anemia on cardiac surgery in octogenarians. Interact Cardiovasc Thorac Surg 10 (2010), 249–255.
45. Muñoz, M, Ariza, D, Gómez-Ramírez, S, et al. Preoperative anemia in elective cardiac surgery. Prevalence, risk factors, and influence on postoperative outcome. Transfus Altern Transfus Med 11 (2010), 47–56.
46. Shirzad, M, Karimi, A, Dowlatshahi, S, et al. Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery. Open Medicine, 5, 2010, 471.
47. Boening, A, Boedeker, R-H, Scheibelhut, C, et al. Anemia before coronary artery bypass surgery as additional risk factor increases the perioperative risk. Ann Thorac Surg 92 (2011), 805–810.
48. Karkouti, K, Wijeysundera, DN, Yau, TM, et al. Influence of erythrocyte transfusion on the risk of acute kidney injury after cardiac surgery differs in anemic and nonanemic patients. Anesthesiology 115 (2011), 523–530.
49. Piednoir, P, Allou, N, Driss, F, et al. Preoperative iron deficiency increases transfusion requirements and fatigue in cardiac surgery patients. A prospective observational study. Eur J Anaesthesiol 28 (2011), 796–801.
50. van Mieghem, NM, Nuis, R-J, Tzikas, A, et al. Prevalence and prognostic implications of baseline anaemia in patients undergoing transcatheter aortic valve implantation. EuroIntervention 7 (2011), 184–191.
51. Hung, M, Besser, M, Sharples, LD, et al. The prevalence and association with transfusion, intensive care unit stay and mortality of pre-operative anaemia in a cohort of cardiac surgery patients. Anaesthesia 66 (2011), 812–818.
52. Mirhosseini, SJ, Sayegh, SAH., Effect of preoperative anemia on short term clinical outcomes in diabetic patients after elective off-pump CABG surgery. Acta Med Iran 50 (2012), 615–618.
53. Ranucci, M, Di Dedda, U, Castelvecchio, S, et al. Impact of preoperative anemia on outcome in adult cardiac surgery. A propensity-matched analysis. Ann Thorac Surg 94 (2012), 1134–1141.
54. David, O, Sinha, R, Robinson, K, et al. The prevalence of anaemia, hypochromia and microcytosis in preoperative cardiac surgical patients. Anaesth Intensive Care 41 (2013), 316–321.
55. Elmistekawy, E, Rubens, F, Hudson, C, et al. Preoperative anaemia is a risk factor for mortality and morbidity following aortic valve surgery. Eur J Cardiothorac Surg 44 (2013), 1051–1055.
56. Matsuda, S, Fukui, T, Shimizu, J, et al. Associations between preoperative anemia and outcomes after off-pump coronary artery bypass grafting. Ann Thorac Surg 95 (2013), 854–860.
57. Nuis, R-J, Sinning, J-M, Rodés-Cabau, J, et al. Prevalence, factors associated with, and prognostic effects of preoperative anemia on short- and long-term mortality in patients undergoing transcatheter aortic valve implantation. Circ Cardiovasc Interv 6 (2013), 625–634.
58. van Straten, AHM, Külcü, K, Özdemir, HI, et al. Preoperative hemoglobin level as a predictor of mortality after aortic valve replacement. J Cardiothorac Vasc Anesth 27 (2013), 716–722.
59. Ranucci, M, Baryshnikova, E, Castelvecchio, S, et al. Major bleeding, transfusions, and anemia. The deadly triad of cardiac surgery. Ann Thorac Surg 96 (2013), 478–485.
60. Zhang, L, Hiebert, B, Zarychanski, R, et al. Preoperative anemia does not increase the risks of early surgical revascularization after myocardial infarction. Ann Thorac Surg 95 (2013), 542–547.
61. Engoren, M, Schwann, TA, Habib, RH, et al. The independent effects of anemia and transfusion on mortality after coronary artery bypass. Ann Thorac Surg 97 (2014), 514–520.
62. Miceli, A, Romeo, F, Glauber, M, et al. Preoperative anemia increases mortality and postoperative morbidity after cardiac surgery. J Cardiothorac Surg, 9, 2014, 137.
63. Scrascia, G, Guida, P, Caparrotti, SM, et al. Incremental value of anemia in cardiac surgical risk prediction with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II model. Ann Thorac Surg 98 (2014), 869–875.
64. Hung, M, Ortmann, E, Besser, M, et al. A prospective observational cohort study to identify the causes of anaemia and association with outcome in cardiac surgical patients. Heart 101 (2015), 107–112.
65. Joshi, SS, George, A, Manasa, D, et al. Propensity-matched analysis of association between preoperative anemia and in-hospital mortality in cardiac surgical patients undergoing valvular heart surgeries. Ann Card Anaesth 18 (2015), 373–379.
66. 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. Can J Anaesth 62 (2015), 377–384.
67. Kim, CJ, Connell, H, McGeorge, AD, et al. Prevalence of preoperative anaemia in patients having first-time cardiac surgery and its impact on clinical outcome. A retrospective observational study. Perfusion 30 (2015), 277–283.
68. Spiegelstein, D, Holmes, SD, Pritchard, G, et al. Preoperative hematocrit as a predictor of perioperative morbidities following nonemergent coronary artery bypass surgery. J Card Surg 30 (2015), 20–26.
69. Deepak, B, Balaji, A, Pramod, A, et al. The prevalence and impact of preoperative anemia in patients undergoing cardiac surgery for rheumatic heart disease. J Cardiothorac Vasc Anesth 30 (2016), 896–900.
70. Hallward, G, Balani, N, McCorkell, S, et al. The relationship between preoperative hemoglobin concentration, use of hospital resources, and outcomes in cardiac surgery. J Cardiothorac Vasc Anesth 30 (2016), 901–908.
71. Padmanabhan, H, Aktuerk, D, Brookes, MJ, et al. Anemia in cardiac surgery. Next target for mortality and morbidity improvement?. Asian Cardiovasc Thorac Ann 24 (2016), 12–17.
72. Ogami, T, Matsue, Y, Kawasumi, R, et al. Prognostic implications of preoperative chronic kidney disease and anemia in patients undergoing coronary artery bypass graft surgery. Surg Today 47 (2017), 245–251.
73. Seiffert, M, Conradi, L, Gutwein, A, et al. Baseline anemia and its impact on midterm outcome after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 89 (2017), E44–E52.
74. Tauriainen, T, Koski-Vähälä, J, Kinnunen, E-M, et al. The effect of preoperative anemia on the outcome after coronary surgery. World J Surg 41 (2017), 1910–1918.
75. Blaudszun, G, Munting, KE, Butchart, A, et al. The association between borderline pre-operative anaemia in women and outcomes after cardiac surgery. A cohort study. Anaesthesia 73 (2018), 572–578.
76. Dai, L, Mick, SL, McCrae, KR, et al. Preoperative anemia in cardiac operation. Does hemoglobin tell the whole story?. Ann Thorac Surg 105 (2018), 100–107.
77. Karkouti, K, Yip, P, Chan, C, et al. Pre-operative anaemia, intra-operative hepcidin concentration and acute kidney injury after cardiac surgery. A retrospective observational study. Anaesthesia 73 (2018), 1097–1102.
78. LaPar, DJ, Hawkins, RB, McMurry, TL, et al. Preoperative anemia versus blood transfusion. Which is the culprit for worse outcomes in cardiac surgery?. J Thorac Cardiovasc Surg 156 (2018), 66–74.
79. Miles, LF, Kunz, SA, Na, LH, et al. Postoperative outcomes following cardiac surgery in non-anaemic iron-replete and iron-deficient patients - an exploratory study. Anaesthesia 73 (2018), 450–458.
80. Oprea, AD, Del Rio, JM, Cooter, M, et al. Anémie pré- et postopératoire, insuffisance rénale aiguë, et mortalité après une chirurgie de pontage aortocoronarien. Une étude observationnelle rétrospective. Can J Anaesth 65 (2018), 46–59.
81. Kassebaum, NJ, Jasrasaria, R, Naghavi, M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood 123 (2014), 615–624.
82. Goodnough, LT, Schrier, SL., Evaluation and management of anemia in the elderly. Am J Hematol 89 (2014), 88–96.
83. Camaschella, C, Iron-deficiency anemia. N Engl J Med 372 (2015), 1832–1843.
84. Karski, JM, Mathieu, M, Cheng, D, et al. Etiology of preoperative anemia in patients undergoing scheduled cardiac surgery. Can J Anaesth 46 (1999), 979–982.
85. Abraham, J, Sinha, R, Robinson, K, et al. Aetiology of preoperative anaemia in patients undergoing elective cardiac surgery-the challenge of pillar one of Patient Blood Management. Anaesth Intensive Care 45 (2017), 46–51.
86. World Health Organisation, Centers of Disease Control and Prevention, https://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/9789241596107/en/.
87. Camaschella, C, Iron-deficiency anemia. N Engl J Med 373 (2015), 485–486.
88. Muñoz, M, Acheson, AG, Auerbach, M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia 72 (2017), 233–247.
89. Goodnough, LT, Maniatis, A, Earnshaw, P, et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient. NATA guidelines. Br J Anaesth 106 (2011), 13–22.
90. Srinivasan, B, Finkelstein, JL, O'Dell, D, et al. Rapid diagnostics for point-of-care quantification of soluble transferrin receptor. EBioMedicine 42 (2019), 504–510.
91. Wells, AW, Mounter, PJ, Chapman, CE, et al. Where does blood go? Prospective observational study of red cell transfusion in north England. BMJ, 325, 2002, 803.
92. Stover, EP, Siegel, LC, Parks, R, et al. Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines. A 24-institution study. Institutions of the Multicenter Study of Perioperative Ischemia Research Group. Anesthesiology 88 (1998), 327–333.
93. Baron, DM, Hochrieser, H, Posch, M, et al. Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. Br J Anaesth 113 (2014), 416–423.
94. Musallam, KM, Tamim, HM, Richards, T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery. A retrospective cohort study. Lancet 378 (2011), 1396–1407.
95. Ellermann, I, Bueckmann, A, Eveslage, M, et al. Treating anemia in the preanesthesia assessment clinic. Results of a retrospective evaluation. Anesth Analg 127 (2018), 1202–1210.
96. Yang, Y, Li, H, Li, B, et al. Efficacy and safety of iron supplementation for the elderly patients undergoing hip or knee surgery. A meta-analysis of randomized controlled trials. J Surg Res 171 (2011), e201–e207.
97. Rozen-Zvi, B, Gafter-Gvili, A, Zingerman, B, et al. Intravenous iron supplementation after kidney transplantation. Clin Transplant 26 (2012), 608–614.
98. 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. Ann Surg 264 (2016), 203–211.
99. ten Broeke, R, Bravenboer, B, Smulders, FJF, Iron deficiency before and after bariatric surgery. The need for iron supplementation. Neth J Med 71 (2013), 412–417.
100. Weltert, L, Rondinelli, B, Bello, R, et al. A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery. Results of a prospective single-blind randomized controlled trial. Transfusion 55 (2015), 1644–1654.
101. Yoo, Y-C, Shim, J-K, Kim, J-C, et al. Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery. Anesthesiology 115 (2011), 929–937.
102. Na, H-S, Shin, S-Y, Hwang, J-Y, et al. Effects of intravenous iron combined with low-dose recombinant human erythropoietin on transfusion requirements in iron-deficient patients undergoing bilateral total knee replacement arthroplasty. Transfusion 51 (2011), 118–124.
103. Muñoz, M, Gómez-Ramírez, S, Cuenca, J, et al. Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery. A pooled analysis of observational data from 2547 patients. Transfusion 54 (2014), 289–299.
104. Konishi, T, Ohbayashi, T, Kaneko, T, et al. Preoperative use of erythropoietin for cardiovascular operations in anemia. Ann Thorac Surg 56 (1993), 101–103.
105. Gurusamy, KS, Nagendran, M, Broadhurst, JF, et al. Iron therapy in anaemic adults without chronic kidney disease. Cochrane Database Syst Rev, 31, 2014, CD010640.
106. Johansson, PI, Rasmussen, AS, Thomsen, LL, Intravenous iron isomaltoside 1000 (Monofer) 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 Sang 109 (2015), 257–266.
107. Cladellas, M, Farré, N, Comín-Colet, J, et al. Effects of preoperative intravenous erythropoietin plus iron on outcome in anemic patients after cardiac valve replacement. Am J Cardiol 110 (2012), 1021–1026.
108. Spahn, DR, Schoenrath, F, Spahn, GH, et al. Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery. A prospective randomised trial. Lancet 393 (2019), 2201–2212.
109. Chau, M, Richards, T, Evans, C, et al. 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. BMJ Open, 7, 2017, e014872.
110. Brewster, UC, Coca, SG, Reilly, RF, et al. Effect of intravenous iron on haemodialysis catheter microbial colonization and blood-borne infection. Nephrology (Carlton) 10 (2005), 124–128.
111. Aronoff, GR, Bennett, WM, Blumenthal, S, et al. Iron sucrose in hemodialysis patients. Safety of replacement and maintenance regimens. Kidney Int 66 (2004), 1193–1198.
112. Pieracci, FM, Henderson, P, Rodney, JRM, et al. Randomized, double-blind, placebo-controlled trial of effects of enteral iron supplementation on anemia and risk of infection during surgical critical illness. Surg Infect (Larchmt) 10 (2009), 9–19.
113. Cieri, E., Does iron cause bacterial infections in patients with end stage renal disease?. ANNA J 26 (1999), 591–596.
114. Avni, T, Bieber, A, Grossman, A, et al. The safety of intravenous iron preparations. Systematic review and meta-analysis. Mayo Clin Proc 90 (2015), 12–23.
115. Partridge, J, Harari, D, Gossage, J, et al. Anaemia in the older surgical patient. A review of prevalence, causes, implications and management. J R Soc Med 106 (2013), 269–277.
116. Weiss, G, Ganz, T, Goodnough, LT, Anemia of inflammation. Blood 133 (2019), 40–50.
117. Litton, E, Baker, S, Erber, WN, et al. Intravenous iron or placebo for anaemia in intensive care. The IRONMAN multicentre randomized blinded trial: A randomized trial of IV iron in critical illness. Intensive Care Med 42 (2016), 1715–1722.
118. Torres, S, Kuo, Y-H, Morris, K, et al. Intravenous iron following cardiac surgery does not increase the infection rate. Surg Infect (Larchmt) 7 (2006), 361–366.
119. Litton, E, Xiao, J, Ho, KM, Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion. Systematic review and meta-analysis of randomised clinical trials. BMJ, 347, 2013, f4822.
120. Khalafallah, AA, Yan, C, Al-Badri, R, et al. Intravenous ferric carboxymaltose versus standard care in the management of postoperative anaemia. A prospective, open-label, randomised controlled trial. Lancet Haematol 3 (2016), e415–e425.
121. Meybohm, P, Goehring, MH, Choorapoikayil, S, et al. Feasibility and efficiency of a preoperative anaemia walk-in clinic. Secondary data from a prospective observational trial. Br J Anaesth 118 (2017), 625–626.
122. Butcher, A, Richards, T, Stanworth, SJ, et al. Diagnostic criteria for pre-operative anaemia-time to end sex discrimination. Anaesthesia 72 (2017), 811–814.
123. Mueller, MM, van Remoortel, H, Meybohm, P, et al. Patient Blood Management. recommendations from the 2018 Frankfurt Consensus Conference. JAMA 321 (2019), 983–997.
124. Andrès, E, Dali-Youcef, N, Vogel, T, et al. Oral cobalamin (vitamin B(12)) treatment. An update. Int J Lab Hematol 31 (2009), 1–8.
125. Ferraris, VA, Brown, JR, Despotis, GJ, et al. 2011 Update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 91 (2011), 944–982.
126. Pagano, D, Milojevic, M, Meesters, MI, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg 53 (2018), 79–111.
127. NICE National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/savingsandproductivityandlocalpracticeresource?id=2625. Assessed 31 August 2018.
128. Duce, L, Cooter, ML, McCartney, SL, et al. Outcomes in patients undergoing cardiac surgery who decline transfusion and received erythropoietin compared to patients who did not. A matched cohort study. Anesth Analg 127 (2018), 490–495.
129. Yazicioğlu, L, Eryilmaz, S, Sirlak, M, et al. Recombinant human erythropoietin administration in cardiac surgery. J Thorac Cardiovasc Surg 122 (2001), 741–745.
130. Urena, M, Del Trigo, M, Altisent, OA-J, et al. Combined erythropoietin and iron therapy for anaemic patients undergoing transcatheter aortic valve implantation. The EPICURE randomised clinical trial. EuroIntervention 13 (2017), 44–52.
131. Forgie, MA, Wells, PS, Laupacis, A, et al. Preoperative autologous donation decreases allogeneic transfusion but increases exposure to all red blood cell transfusion. Results of a meta-analysis. International Study of Perioperative Transfusion (ISPOT) Investigators. Arch Intern Med 158 (1998), 610–616.
132. Henry, DA, Carless, PA, Moxey, AJ, et al. Pre-operative autologous donation for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev, 2002, CD003602.
133. Dupuis, JY, Bart, B, Bryson, G, et al. Transfusion practices among patients who did and did not predonate autologous blood before elective cardiac surgery. CMAJ 160 (1999), 997–1002.
134. Consensus conference. Perioperative red blood cell transfusion. JAMA 260 (1988), 2700–2703.
135. American Society of Anesthesiologists. Questions and answers about transfusion practices. 3rd ed, 1998, American Society of Anesthesiologists, Park Ridge, IL, 1–32.
136. Goldberg, J, Paugh, TA, Dickinson, TA, et al. Greater volume of acute normovolemic hemodilution may aid in reducing blood transfusions after cardiac surgery. Ann Thorac Surg 100 (2015), 1581–1587.
137. Casati, V, Benussi, S, Sandrelli, L, et al. Intraoperative moderate acute normovolemic hemodilution associated with a comprehensive blood-sparing protocol in off-pump coronary surgery. Anesth Analg 98 (2004), 1217–1223 table of contents.
138. Höhn, L, Schweizer, A, Licker, M, et al. Absence of beneficial effect of acute normovolemic hemodilution combined with aprotinin on allogeneic blood transfusion requirements in cardiac surgery. Anesthesiology 96 (2002), 276–282.
139. Zhou, Z-F, Jia, X-P, Sun, K, et al. Mild volume acute normovolemic hemodilution is associated with lower intraoperative transfusion and postoperative pulmonary infection in patients undergoing cardiac surgery – a retrospective, propensity matching study. BMC Anesthesiol, 17, 2017, 13.
140. Puskas, JD, Martin, J, Cheng, DCH, et al. ISMICS Consensus Conference and statements of randomized controlled trials of off-pump versus conventional coronary artery bypass surgery. Innovations (Phila) 10 (2015), 219–229.
141. Deppe, A-C, Arbash, W, Kuhn, EW, et al. Current evidence of coronary artery bypass grafting off-pump versus on-pump. A systematic review with meta-analysis of over 16,900 patients investigated in randomized controlled trials. Eur J Cardiothorac Surg 49 (2016), 1031–1041 discussion 1041.
142. Lamy, A, Devereaux, PJ, Prabhakaran, D, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 366 (2012), 1489–1497.
143. Diegeler, A, Börgermann, J, Kappert, U, et al. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med 368 (2013), 1189–1198.
144. Chaudhry, UAR, Harling, L, Sepehripour, AH, et al. Beating-heart versus conventional on-pump coronary artery bypass grafting. A meta-analysis of clinical outcomes. Ann Thorac Surg 100 (2015), 2251–2260.
145. Falk, V, Cheng, DCH, Martin, J, et al. Minimally invasive versus open mitral valve surgery. A consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010. Innovations (Phila) 6 (2011), 66–76.
146. Harling, L, Warren, OJ, Martin, A, et al. Do miniaturized extracorporeal circuits confer significant clinical benefit without compromising safety? A meta-analysis of randomized controlled trials. ASAIO J 57 (2011), 141–151.
147. Anastasiadis, K, Antonitsis, P, Haidich, A-B, et al. Use of minimal extracorporeal circulation improves outcome after heart surgery; a systematic review and meta-analysis of randomized controlled trials. Int J Cardiol 164 (2013), 158–169.
148. Varghese, R, Myers, ML., Blood conservation in cardiac surgery. Let's get restrictive. Semin Thorac Cardiovasc Surg 22 (2010), 121–126.
149. Carless, PA, Henry, DA, Moxey, AJ, et al. Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev, 14, 2010, CD001888.
150. Vonk, ABA, Meesters, MI, Garnier, RP, et al. Intraoperative cell salvage is associated with reduced postoperative blood loss and transfusion requirements in cardiac surgery. A cohort study. Transfusion 53 (2013), 2782–2789.
151. Murphy, GJ, Allen, SM, Unsworth-White, J, et al. Safety and efficacy of perioperative cell salvage and autotransfusion after coronary artery bypass grafting. A randomized trial. Ann Thorac Surg 77 (2004), 1553–1559.
152. Niranjan, G, Asimakopoulos, G, Karagounis, A, et al. Effects of cell saver autologous blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing cardiac surgery on- versus off-cardiopulmonary bypass. A randomised trial. Eur J Cardiothorac Surg 30 (2006), 271–277.
153. Djaiani, G, Fedorko, L, Borger, MA, et al. Continuous-flow cell saver reduces cognitive decline in elderly patients after coronary bypass surgery. Circulation 116 (2007), 1888–1895.
154. Rubens, FD, Boodhwani, M, Mesana, T, et al. The cardiotomy trial. A randomized, double-blind study to assess the effect of processing of shed blood during cardiopulmonary bypass on transfusion and neurocognitive function. Circulation 116 (2007), I89–I97.
155. Al-Riyami, AZ, Al-Khabori, M, Baskaran, B, et al. Intra-operative cell salvage in cardiac surgery may increase platelet transfusion requirements. A cohort study. Vox Sang 109 (2015), 280–286.
156. Meybohm, P, Choorapoikayil, S, Wessels, A, et al. Washed cell salvage in surgical patients. A review and meta-analysis of prospective randomized trials under PRISMA. Medicine (Baltimore), 95, 2016, e4490.
157. Klein, AA, Bailey, CR, Charlton, AJ, et al. Association of Anaesthetists guidelines. Cell salvage for peri-operative blood conservation 2018. Anaesthesia 73 (2018), 1141–1150.
158. Hajjar, LA, Vincent, J-L, Galas, FRBG, et al. Transfusion requirements after cardiac surgery. The TRACS randomized controlled trial. JAMA 304 (2010), 1559–1567.
159. Mazer, CD, Whitlock, RP, Fergusson, DA, et al. Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med 377 (2017), 2133–2144.
160. Mazer, CD, Whitlock, RP, Fergusson, DA, et al. Six-month outcomes after restrictive or liberal transfusion for cardiac surgery. N Engl J Med 379 (2018), 1224–1233.
161. Murphy, GJ, Pike, K, Rogers, CA, et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med 372 (2015), 997–1008.
162. Shehata, N, Mistry, N, da Costa, BR, et al. Restrictive compared with liberal red cell transfusion strategies in cardiac surgery. A meta-analysis. Eur Heart J 40 (2019), 1081–1088.
163. Tramarin, R, Pistuddi, V, Maresca, L, et al. Patterns and determinants of functional and absolute iron deficiency in patients undergoing cardiac rehabilitation following heart surgery. Eur J Prev Cardiol 24 (2017), 799–807.
164. 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. J Cardiothorac Vasc Anesth 18 (2004), 59–63.
165. Garrido-Martín, P, Nassar-Mansur, MI, La Llana-Ducrós, R de, 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. Interact Cardiovasc Thorac Surg 15 (2012), 1013–1018.
166. Vincent, JL, Anemia and blood transfusion in critically ill patients. JAMA, 288, 2002, 1499.
167. Riessen, R, Behmenburg, M, Blumenstock, G, et al. A Simple “blood-saving bundle” reduces diagnostic blood loss and the transfusion rate in mechanically ventilated patients. PLoS ONE, 10, 2015, e0138879.
168. Sanchez-Giron, F, Alvarez-Mora, F., Reduction of blood loss from laboratory testing in hospitalized adult patients using small-volume (pediatric) tubes. Arch Pathol Lab Med 132 (2008), 1916–1919.
169. Koch, CG, Reineks, EZ, Tang, AS, et al. Contemporary bloodletting in cardiac surgical care. Ann Thorac Surg 99 (2015), 779–784.
170. Rogers, CA, Stoica, S, Ellis, L, et al. Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery. Br J Anaesth 119 (2017), 384–393.
171. Wong, W-T, Lai, VK, Chee, YE, et al. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev, 9, 2016, CD003587.
172. Mbanya, D., Barriers and enablers to introducing comprehensive patient blood management in the hospital. Biologicals 40 (2012), 205–208.
173. Cabana, MD, Rand, CS, Powe, NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 282 (1999), 1458–1465.
174. University Hospital Frankfurt: Patient Blood Management, 2017. Available at: http://www.patientbloodmanagement.eu. Accessed 31 August 2018.
175. University Hospital Frankfurt: Patient Blood Manager. Available at: http://www.patientbloodmanager.com. Accessed 31 August 2018.
176. Karkouti, K, McCluskey, SA, Ghannam, M, et al. Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia. Can J Anaesth 53 (2006), 11–19.