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  1. Article ; Online: Perioperative management of anemia: limits of blood transfusion and alternatives to it.

    Kumar, Ajay

    Cleveland Clinic journal of medicine

    2009  Volume 76 Suppl 4, Page(s) S112–8

    Abstract: Perioperative anemia is associated with excess morbidity and mortality. Transfusion of allogeneic ... blood has been a longstanding strategy for managing perioperative anemia, but the blood supply is ... been developing a blood management program aimed at reducing allogeneic blood exposure for greater ...

    Abstract Perioperative anemia is associated with excess morbidity and mortality. Transfusion of allogeneic blood has been a longstanding strategy for managing perioperative anemia, but the blood supply is insufficient to meet transfusion needs, and complications such as infection, renal injury, and acute lung injury are fairly common. Further, data suggest that mortality and length of stay are worsened with liberal use of transfusion. Medical alternatives to transfusion include iron supplementation and erythropoiesis-stimulating agents (ESAs). Though ESAs reduce the need for perioperative blood transfusion compared with placebo, they are associated with an increased risk of thrombotic events in surgical patients. Cleveland Clinic has been developing a blood management program aimed at reducing allogeneic blood exposure for greater patient safety; the program has achieved some reduction in blood utilization in its first 7 months.
    MeSH term(s) Anemia/drug therapy ; Anemia/etiology ; Anemia/therapy ; Blood Transfusion ; Hematinics/therapeutic use ; Humans ; Iron Compounds/therapeutic use ; Perioperative Care ; Risk Factors
    Chemical Substances Hematinics ; Iron Compounds
    Language English
    Publishing date 2009-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 639116-3
    ISSN 1939-2869 ; 0891-1150
    ISSN (online) 1939-2869
    ISSN 0891-1150
    DOI 10.3949/ccjm.76.s4.18
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Perioperative anaemia management: consensus statement on the role of intravenous iron.

    Beris, P / Muñoz, M / García-Erce, J A / Thomas, D / Maniatis, A / Van der Linden, P

    British journal of anaesthesia

    2008  Volume 100, Issue 5, Page(s) 599–604

    Abstract: ... haemoglobin levels and reduce blood transfusion in patients undergoing surgery, and to develop a consensus ... Alternatives to review the evidence on the efficacy and safety of i.v. iron administration to increase ... The two RCTs had serious limitations and the six observational limited by the selection ...

    Abstract A multidisciplinary panel of physicians was convened by Network for Advancement of Transfusion Alternatives to review the evidence on the efficacy and safety of i.v. iron administration to increase haemoglobin levels and reduce blood transfusion in patients undergoing surgery, and to develop a consensus statement on perioperative use of i.v. iron as a transfusion alternative. After conducting a systematic literature search to identify the relevant studies, critical evaluation of the evidence was performed and recommendations formulated using the Grades of Recommendation Assessment, Development and Evaluation Working Group methodology. Two randomized controlled trials (RCTs) and six observational studies in orthopaedic and cardiac surgery were evaluated. Overall, there was little benefit found for the use of i.v. iron. At best, i.v. iron supplementation was found to reduce the proportion of patients requiring transfusions and the number of transfused units in observational studies in orthopaedic surgery but not in cardiac surgery. The two RCTs had serious limitations and the six observational limited by the selection of the control groups. Thus, the quality of the available evidence is considered moderate to very low. For patients undergoing orthopaedic surgery and expected to develop severe postoperative anaemia, the panel suggests i.v. iron administration during the perioperative period (weak recommendation based on moderate/low-quality evidence). For all other types of surgery, no evidence-based recommendation can be made. The panel recommends that large, prospective, RCTs be undertaken to evaluate the efficacy and safety of i.v. iron administration in surgical patients. The implementation of some general good practice points is suggested.
    MeSH term(s) Anemia/therapy ; Evidence-Based Medicine ; Humans ; Injections, Intravenous ; Iron/administration & dosage ; Iron/adverse effects ; Iron/therapeutic use ; Perioperative Care/methods ; Professional Practice/standards ; Treatment Outcome
    Chemical Substances Iron (E1UOL152H7)
    Language English
    Publishing date 2008-05
    Publishing country England
    Document type Consensus Development Conference ; Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1093/bja/aen054
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Uk I Zs.80: Show issues Location:
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