Management of Perioperative Iron Deficiency Anemia

Gómez‐Ramírez, Susana; Bisbe, E.; Shander, Aryeh; Spahn, Donat R.; Múñoz, Manuel

doi:10.1159/000496965

Cited by 76 publications

(64 citation statements)

References 53 publications

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“…Conventional therapeutic approaches advocate the diagnosis and treatment of anemia before any surgical procedure. Iron deficiency without anemia needs to be treated to replenish iron stores for preoperative requirements and postoperative anemia challenge [38]. Preoperative oral iron could be prescribed for mild-to-moderate anemia patients that are tolerant and do not suffer from adverse gastrointestinal consequences.…”

Section: Anemia Of Surgerymentioning

confidence: 99%

“…Patient blood management (PBM) that involves evaluation of the hematological status of patients will not only prevent preoperative anemia, but also reduce intraoperative transfusion risk and postoperative complications [41]. Recent guidelines and recommendations advocate a preoperative Hb <13 g/dL to be considered as suboptimal in both men and women and treated before any major surgical procedure [38].…”

Section: Anemia Of Surgerymentioning

confidence: 99%

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Anemia of Inflammation with An Emphasis on Chronic Kidney Disease

Begum

Latunde-Dada

2019

Nutrients

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Iron is vital for a vast variety of cellular processes and its homeostasis is strictly controlled and regulated. Nevertheless, disorders of iron metabolism are diverse and can be caused by insufficiency, overload or iron mal-distribution in tissues. Iron deficiency (ID) progresses to iron-deficiency anemia (IDA) after iron stores are depleted. Inflammation is of diverse etiology in anemia of chronic disease (ACD). It results in serum hypoferremia and tissue hyperferritinemia, which are caused by elevated serum hepcidin levels, and this underlies the onset of functional iron-deficiency anemia. Inflammation is also inhibitory to erythropoietin function and may directly increase hepcidin level, which influences iron metabolism. Consequently, immune responses orchestrate iron metabolism, aggravate iron sequestration and, ultimately, impair the processes of erythropoiesis. Hence, functional iron-deficiency anemia is a risk factor for several ailments, disorders and diseases. Therefore, therapeutic strategies depend on the symptoms, severity, comorbidities and the associated risk factors of anemia. Oral iron supplements can be employed to treat ID and mild anemia particularly, when gastrointestinal intolerance is minimal. Intravenous (IV) iron is the option in moderate and severe anemic conditions, for patients with compromised intestinal integrity, or when oral iron is refractory. Erythropoietin (EPO) is used to treat functional iron deficiency, and blood transfusion is restricted to refractory patients or in life-threatening emergency situations. Despite these interventions, many patients remain anemic and do not respond to conventional treatment approaches. However, various novel therapies are being developed to treat persistent anemia in patients.

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Section: Anemia Of Surgerymentioning

confidence: 99%

Section: Anemia Of Surgerymentioning

confidence: 99%

Anemia of Inflammation with An Emphasis on Chronic Kidney Disease

Begum

Latunde-Dada

2019

Nutrients

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“…C-reactive protein, used to assess the patient’s inflammatory status, can guide iron’s deficiency diagnosis. In the presence of low ferritin (30–100 ng/mL) and transferrin saturation levels (<20%), a level of C-reactive protein below 5 mg/L is a marker of absolute iron deficiency [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods

et al. 2020

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Iron deficiency is a major problem in worldwide populations, being more alarming in surgical patients. In the presence of absolute iron deficiency (depletion of body iron), functional iron deficiency (during intense bone marrow stimulation by endogenous or exogenous factors), or iron sequestration (acute or chronic inflammatory conditions), iron-restricted erythropoiesis can develop. This systemic review was conducted to draw attention to the delicate problem of perioperative anemia, and to provide solutions to optimize the management of anemic surgical patients. Systemic reviews and meta-analyses, clinical studies and trials, case reports and international guidelines were studied, from a database of 50 articles. Bone marrow biopsy, serum ferritin levels, transferrin saturation, the mean corpuscular volume, and mean corpuscular hemoglobin concentration were used in the diagnosis of iron deficiency. There are various intravenous iron formulations, with different pharmacological profiles used for restoring iron. In surgical patients, anemia is an independent risk factor for morbidity and mortality. Therefore, anemia correction should be rapid, with parenteral iron formulations—the oral ones—being inefficient. Various studies showed the safety and efficacy of parenteral iron formulations in correcting hemoglobin levels and decreasing the blood transfusion rate, the overall mortality, the postoperative infections incidence, hospitalization days, and the general costs.

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“…This recent consensus, as well as other publications,4,6 were a motivation to analyze the criteria to be satisfied for selecting an iron adapted to our practice in gynecology. Intravenous irons were not discussed during the symposium and this information is available elsewhere 26–29. The high number of available iron-containing products precluded a thorough analysis and comparison of the oral supplements 30,31…”

Section: Management Of Iron Deficiency Anemia Pre-surgery: Which Iron?mentioning

confidence: 99%

<p>Recovery after surgery: do not forget to check iron status before</p>

Serati

Cetin

Athanasiou

2019

IJWH

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The perioperative period poses a risk for anemia due to the high prevalence of pre-existing anemia secondary to underlying pathologies in patients who are candidates for surgery, and as a result of the increased blood loss caused by surgery. Pre-operative anemia is an independent risk factor associated with higher risk of blood transfusion and negative surgery outcomes. Anemia and iron deficiency (ID), the main causes of pre-operative anemia, can be easily diagnosed with blood testing and are readily treated before elective surgery. However, pre-surgical screening and treatment of anemia and ID are frequently overlooked. These topics were presented and discussed at the symposium entitled “Recovery after Surgery: Don’t Forget to Check Iron Status Before”, held at the 11th Annual Meeting of the European Urogynaecological Association (EUGA) in October 2018 in Milan. The objectives of the symposium were to stress the high prevalence and the consequences of pre-operative anemia, illustrated with three clinical cases of women undergoing surgery, and to choose the best option for iron supplementation. In conclusion, it is essential to take time to diagnose and treat iron deficiency anemia (IDA) before surgery. The first-line treatment is oral iron when surgery can be delayed and when there is no intolerance to oral treatment or inefficient uptake, as in the case of iron sequestration or absorption disorders. Among iron preparations, ferrous sulfate in a polymeric complex (FSPC) was found to be one of the treatments of choice to improve hemoglobin iron stores and quality of life in IDA patients.

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Management of Perioperative Iron Deficiency Anemia

Cited by 76 publications

References 53 publications

Anemia of Inflammation with An Emphasis on Chronic Kidney Disease

Anemia of Inflammation with An Emphasis on Chronic Kidney Disease

Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods

<p>Recovery after surgery: do not forget to check iron status before</p>

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