The effect of anaemia and malnutrition on the healing of diabetic foot wound

Abstract

Background: Anaemia is a common problem in surgical patient, and it is an independent risk factor for blood transfusion, peri-operative infection, mortality and a longer in-patient stay. Diabetic foot wound results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetics, patients with diabetic foot wounds suffer from chronic inflammation, repeated infection, often undergo several invasive or operative treatments, and can have a protracted hospital stay. We hypothesised that, for these reasons, many patients with diabetic foot wound may suffer anaemia, require blood transfusion and suffer from poor nutrition.Aim of the work: Anaemia and nutritional status assessment as they affect the healing in patients presenting with diabetic foot wounds.Patients and methods: Two observational studies were undertaken. Initially a retrospective series of 20 patients with diabetic foot wounds. Patient demographics, clinical details, transfusion status and in-patient laboratory haemoglobin values (Hb) were recorded. In a prospective series of 33 patients, laboratory markers and nutritional status were assessed. Infection was excluded and managed appropriately by antibiotics and surgically by wound debridement or amputation. Other factors affecting wound healing were excluded as peripheral arterial diseases or debilitating diseases as renal failure.Results: In the retrospective series, 17 patients (85%) were anaemic (100% females) with average haemoglobin of 5g (SD 2.4) below the lower limit of normal for the sex of the patients. Ten patients (50%) were transfused. The average trigger haemoglobin index was 8.5 g/dl (SD 0.8). Patients who were transfused had lower haemoglobin on admission (p = 0.0016). Overall, at discharge, most of the patients were anaemic (92%). In the prospective series on admission, 27 patients (82%) were anaemic, also anaemic patients had a higher CRP and lower albumin level. 17 patients (52%) had been scored to be undernourished. Clinical follow up with appropriate dressing of the wounds and calculating the healing rate was observed. Conclusion:Usually anaemia as well as poor nutrition is the normal event and affecting the healing of diabetic wounds. Multidisciplinary review should be undertaken in all patients.