Simplified diagnostic algorithm for classification of preoperative anaemia based on complete blood count and its application in elective gastrointestinal surgery

Czempik, Piotr F.; Czepczor, Kinga; Czok, Marcelina; Pluta, Michał; Krzych, Łukasz J.

doi:10.5604/01.3001.0013.2569

Cited by 3 publications

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“…It is wise to correct modifiable patient factors contributing to anemia. Vitamin deficiencies should be replenished: vitamin B12, folic acid, and vitamin D. However, we must remember that vitamin deficiencies are rare in patients hospitalized in the ICU: in one study only 2% of patients had a vitamin B12 deficiency and another 2% had a folic acid deficiency [77], while in another study 2.4% of surgical patients had a vitamin B12/folic acid deficiency [26].…”

Section: Contributory Factorsmentioning

confidence: 99%

“…In clinical scenarios with potential blood loss (e.g. the perioperative period), there is a consensus to use a Hb cut-off value of <13 g/dL for both sexes, as women have lower blood volumes, yet bleed as much as men [25,26].…”

Section: Etiological Classification Of Anemiamentioning

confidence: 99%

“…To conclude, in the absence of thalassemia, low MCV, MCH or MCHC suggest ID, whereas their normal values do not exclude ID. CBC should be the first test for screening and preliminary classification of anemia [26].…”

Section: Erythrocyte Parametersmentioning

confidence: 99%

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Anemia of critical illness: a narrative review

Czempik

Krzych²

2022

Acta Haematol Pol.

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The prevalence of anemia in patients admitted to the intensive care unit (ICU) reaches 66%. Moreover, numerous patients develop anemia during ICU hospitalization. In fact, anemia is the most common hematologic disease in the ICU.The majority of patients hospitalized in the ICU present with acute systemic inflammation, so called systemic inflammatory response syndrome (SIRS). These patients may develop anemia of inflammation (AI). In crtitically ill patients AI may present acutely (acute systemic inflammation) or chronically (comorbidities associated with prolonged systemic inflammation), here we describe both presentations of AI as 'anemia of critical illness' (ACI). The second most frequent type of anemia in critically ill patients is iron-deficiency anemia (IDA). A mixed type of anemia (ACI + IDA) may also be present in these patients.The three major pathophysiological mechanisms leading to ACI are: iron restriction, decreased erythropoiesis, and decreased erythrocyte lifespan. Cytokines synthesized during SIRS induce the production of hepcidin that inhibits the only transmembrane iron exporter (ferroportin) present in the duodenum and macrophages.Etiological classification of anemia in critically ill patients poses a significant challenge to clinicians, as there is a multitude of tests available, and there are various reference ranges for these tests reported in the literature in the patient population in question. Pure ACI or mixed ACI + IDA can be diagnosed using a single laboratory test -complete blood count with analysis of reticulocytes -which provides Hb concentration in erythrocyte and reticulocyte.The management of ACI incorporates discontinuation with erythropoiesis-stimulating agent causing anemia, reduction of iatrogenic blood loss, parenteral iron, and combined therapy of parenteral iron with erythropoiesis-stimulating agents in approved indications.

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Section: Contributory Factorsmentioning

confidence: 99%

Section: Etiological Classification Of Anemiamentioning

confidence: 99%

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Anemia of critical illness: a narrative review

Czempik

Krzych²

2022

Acta Haematol Pol.

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“…The frequency of IDA among critically ill patients is not known. Although algorithms for differential diagnosis of preoperative anemia have been proposed [9,10], there are no algorithms for Piotr F. Czempik et al, Ferritin and transferrin saturation cannot be used for diagnosis of IDA in critically ill patients diagnosis of IDA in critically ill patients. Ferritin concentration and transferrin saturation are standard tests used for diagnosis of ID in most guidelines according to a recent systematic review [11].…”

Section: Introductionmentioning

confidence: 99%

Ferritin and transferrin saturation cannot be used to diagnose iron-deficiency anemia in critically ill patients

2021

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Current approach to the management of preoperative iron-deficiency anemia in colorectal cancer patients – a review of literature

Rudzki,

Polewka,

Agopsowicz

et al. 2024

Pol Przegl Chir

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Introduction: The prevalence of preoperative anemia is highest in the group of colorectal cancer (CRC) patients and may reach over 75%. The prevalence of anemia in CRC patients increases even further following surgery. Approximately 75-80% of anemic CRC patients present with absolute or functional iron deficiency (IDA). Preoperative anemia constitutes an independent risk factor for allogeneic blood transfusion (ABT), postoperative complications, prolonged length of hospital stay, and increased mortality. Allogeneic blood transfusion is itself associated with increased morbidity and mortality.Aim: The aim of this review article was to present the pathophysiology and the current approach to diagnosis and treatment of preoperative IDA in CRC patients.Material and methods: Extensive search of medical literature databases was performed (Pubmed, Embase). The key words that were used were as follows: colorectal cancer, colorectal surgery, iron-deficiency, iron-deficiency anemia, intravenous iron, Patient Blood Management.Results: There are several laboratory parameters that can be used for IDA diagnosis, however the simplest and cost-effective is reticulocyte hemoglobin equivalent. Pathophysiologic features of IDA in CRC patients favor treatment with intravenous, as oppose to oral, iron formulations. Applying Patient Blood Management strategies minimizes the exposure to ABT.Conclusions: Preoperative IDA is highly prevalent among CRC patients. Preoperative anemia is an independent risk factor for ABT, increased morbidity and mortality, as well as prolonged hospital length of stay. The same negative consequences are associated with ABT. Therefore preoperative IDA in CRC patient needs to be screened for, diagnosed, and treated before surgery. Effective treatment of preoperative IDA in CRC patients is with intravenous iron formulations. Allogeneic blood transfusion should be the treatment of last resort due to risk of negative clinical consequences, including increased rate of cancer recurrence.

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Simplified diagnostic algorithm for classification of preoperative anaemia based on complete blood count and its application in elective gastrointestinal surgery

Cited by 3 publications

References 0 publications

Anemia of critical illness: a narrative review

Anemia of critical illness: a narrative review

Ferritin and transferrin saturation cannot be used to diagnose iron-deficiency anemia in critically ill patients

Current approach to the management of preoperative iron-deficiency anemia in colorectal cancer patients – a review of literature

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