Prevalence of iron deficiency and red blood cell transfusions in surgical patients

Abstract

Background and Objectives While iron deficiency (ID) is the most common cause of anaemia, little is known about the prevalence and type of ID in preoperative surgical patients. The aims of the present study were to investigate the prevalence and types of ID in a large cohort of surgical patients, and how these are related to perioperative blood use after correction for confounders such as haemoglobin level. Materials and Methods Data were retrospectively extracted from electronic case records of all patients who underwent elective surgery between September 2016 and November 2017 (n = 2711). Iron parameters, haemoglobin and details of perioperative red cell transfusions were collected. Results Of 2711 patients, 618 (22.8%) were iron deficient (= transferrin saturation [TSAT] < 16%) preoperatively, 173 (6.4% of the cohort) had an absolute iron deficiency (AID; TSAT < 16% and ferritin < 30 μg/L) and 445 (16.4%) had functional/mixed ID (TSAT < 16% and ferritin ≥ 30 μg/L). Corrected for Hb level, iron‐deficient patients received significantly more red cell units than patients without ID (p = 0.026). AID was not associated with a significantly higher incidence of transfusions (7.5% of patients transfused; p = 0.12 after correction for Hb) than patients without ID, whereas patients with functional/mixed deficiency did receive significantly more transfusions (6.1%; p = 0.021) as compared to patients without ID (1.7%). Conclusion Preoperative ID, in particular the functional/mixed type, was associated with a higher risk of receiving perioperative red cell transfusions as compared to patients without ID. Adequately treating ID might, therefore, reduce the need for perioperative red cell transfusions.

Mini-Review on Haemovigilance: an Indian Perspective

“…The Hv structure should preferably encompass all metrics and procedures used throughout the transfusion process, from blood donation to monitoring, reporting, and analysis of AEs and ARs [24,25]. Because of variances in the reporting spectrum, the extent of distinct Hv systems differs:…”

Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes

“…Iron deficiency (ID) is still the top-ranking cause of anemia in the general population worldwide [ 2 ]. In preoperative patients, the prevalence of ID ranges from 23 to 33% [ 3 , 4 ], with a wide variation between surgical fields (e.g., gynecology (59%), plastic surgery (11%)) [ 4 ]. Preoperative anemia is associated with an increased risk of allogeneic blood transfusions, length of hospital stay, morbidity, and mortality [ 4 , 5 ] making ID an important target to diagnose and treat before elective surgery [ 6 ].…”

“…In preoperative patients, the prevalence of ID ranges from 23 to 33% [ 3 , 4 ], with a wide variation between surgical fields (e.g., gynecology (59%), plastic surgery (11%)) [ 4 ]. Preoperative anemia is associated with an increased risk of allogeneic blood transfusions, length of hospital stay, morbidity, and mortality [ 4 , 5 ] making ID an important target to diagnose and treat before elective surgery [ 6 ]. For the detection of ID, serum ferritin (<15 μg/L) as a marker in healthy individuals and in combination with C reactive protein (CRP) in patients with inflammatory conditions (serum ferritin <70 μg/L and CRP >5 mg/L) is recommended in the WHO’s guideline from 2020 [ 7 ].…”

“…Iron supplementation can increase Hb levels in patients with IDA if started in time before an upcoming surgery. Various studies suggested that intravenous (IV) iron supplementation reduces the need for red blood cell transfusions and postoperative complications [ 4 , 5 , 12 – 14 ]. Although there is an immense amount of studies investigating preoperative anemia management, it remains challenging to establish reliable evidence on the efficacy of preoperative iron supplementation [ 14 ].…”

Evaluación y manejo de la anemia en el paciente oncológico

“…5 Dependiendo del pronóstico y el estadio de la enfermedad, las metas pueden cambiar de la corrección de la anemia por cáncer, al mantenimiento de una mejoría en la calidad de vida previniendo el empeoramiento de la anemia y la dependencia de transfusiones. 6 Se sabe que los pacientes oncológicos que serán sometidos a algún procedimiento quirúrgico tendrán un peor pronóstico si al momento de la intervención tienen anemia o si son transfundidos. Por lo que es indispensable contar con un equipo multidisciplinario para la evaluación y manejo de la anemia.…”