An international consensus statement on the management of postoperative anaemia after major surgical procedures

Anaesthesia - Tập 73 Số 11 - Trang 1418-1431 - 2018
Manuel Múñoz1, AG Acheson2, E. Bisbe3, Anna Butcher4, Susana Gómez‐Ramírez5, A Abdallah6,7, Henrik Kehlet8, Sibylle Kietaibl9, Giancarlo Maria Liumbruno10, Patrick Meybohm11, R. Rao Baikady12, Aryeh Shander13,14, Cynthia So‐Osman15,16, Donat R. Spahn17,18, A. A. Klein19
1Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
2Department of Colorectal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Nottingham, UK
3Department of Anaesthesia, University Hospital Mar-Esperanza, Barcelona, Spain
4Division of Surgery, University College London, London, UK
5Department of Internal Medicine University Hospital Virgen de la Victoria Málaga Spain
6Department of Haematology and Medicine, Launceston General Hospital, Launceston, Australia
7Menzies Institute for Medical Research, University of Tasmania, Australia
8Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
9Department of Anaesthesia and Intensive Care, Evangelical Hospital, Vienna, Austria
10Italian National Blood Centre, National Institute of Health, Rome, Italy
11Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
12Department of Anaesthesia, Royal Marsden NHS Foundation Trust, London, UK
13Anaesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Centre, Englewood, NJ, USA
14TeamHealth Research Institute, Englewood, NJ, USA
15Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
16Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
17Institute of Anaesthesiology, University Hospital of Zurich, Zurich, Switzerland
18Intensive Care Medicine and Operating Room Management, University Hospital of Zurich, Zurich, Switzerland
19Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK

Tóm tắt

SummaryDespite numerous guidelines on the management of anaemia in surgical patients, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in the postoperative period. A number of experienced researchers and clinicians took part in a two‐day expert workshop and developed the following consensus statement. After presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best‐practice and evidence‐based statements to advise on patient care with respect to anaemia and iron deficiency in the postoperative period. These statements include: a diagnostic approach to iron deficiency and anaemia in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow‐up that is easy to implement. Available data allow the fulfilment of the requirements of Pillar 1 of Patient Blood Management. We urge national and international research funding bodies to take note of these recommendations, particularly in terms of funding large‐scale prospective, randomised clinical trials that can most effectively address the important clinical questions and this clearly unmet medical need.

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Tài liệu tham khảo

SABM.Anemia prevention and management program implementation guide.2015.https://www.sabm.org/sites/default/files/anemia_prevention_management_program_implementation_guide.pdf(accessed 11/10/2017).

10.1111/trf.14006

10.1093/bja/aev165

10.1111/anae.13773

10.1016/j.tmrv.2016.05.012

10.1111/trf.14095

10.1097/EJA.0000000000000630

10.1093/bja/aen054

National Blood Authority.Patient blood management guidelines: Module 2 ‐ Perioperative.https://www.blood.gov.au/pbm-module-2(accessed 11/10/2017).

Leal‐Noval SR, 2013, Spanish expert panel on alternatives to allogeneic blood transfusion. Spanish consensus statement on alternatives to allogeneic blood transfusion: the 2013 update of the ‘Seville Document’, Blood Transfusion, 11, 585

10.1097/ALN.0000000000000463

NICE guideline [NG24].Blood transfusion.https://www.nice.org.uk/guidance/ng24/chapter/Recommendations#alternatives-to-blood-transfusion-for-patients-having-surgery-2(accessed 27/06/2017).

Vaglio S, 2016, Recommendations for the implementation of a Patient Blood Management programme. Application to elective major orthopaedic surgery in adults, Blood Transfusion, 14, 23

10.1111/bjh.13623

10.1111/tme.12443

10.1016/j.amjmed.2003.12.013

10.1097/ALN.0b013e3181e08e97

WHO.Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. WHO/NMH/NHD/MNM/11.1.http://www.who.int/vmnis/indicators/haemoglobin.pdf(accessed 28/04/2017).

10.1111/anae.13877

Muñoz M, 2016, Patient blood management: multidisciplinary approaches to optimizing care, 233

Hayn D, 2016, Data driven methods for predicting blood transfusion needs in elective surgery, Studies in Health Technology and Informatics, 223, 9

Woodman R, 2005, Anemia in older adults, Current Opinion in Hematology, 12, 123

Gómez‐Ramírez S, 2017, Anaemia in the elderly, Medicina Clinica (Barcelona), 149, 496

10.1097/00003246-200008000-00015

10.1046/j.1365-2168.1998.00571.x

10.1136/jcp.2010.086991

10.1111/trf.12723

10.1111/j.1537-2995.2010.02784.x

10.1111/j.1537-2995.2011.03272.x

10.1111/trf.13508

10.1097/PTS.0000000000000138

10.1213/ANE.0000000000001003

10.1213/ANE.0000000000001190

10.1016/j.thromres.2015.12.025

10.1371/journal.pone.0030065

10.1213/ANE.0000000000000605

10.1111/j.1751-7133.2010.00208.x

10.1136/jcp.2010.079046

10.1016/S2352-3026(16)30078-3

10.1002/ajh.24820

10.1111/ejh.12914

10.1093/bja/aeu092

Muñoz M, 2014, Cost of post‐operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study, Blood Transfusion, 12, 40

10.1111/vox.12278

10.1001/jama.2017.5703

10.1111/vox.12477

Liumbruno GM, 2011, Rossetti G; Italian Society of Transfusion Medicine and Immunohaematology Working Party. Recommendations for the transfusion management of patients in the peri‐operative period. III. The post‐operative period, Blood Transfusion, 9, 320

10.1111/anae.13489

Carson JL, 2016, Red blood cell transfusion: 2016 clinical practice guideline from the AABB, Annals of Internal Medicine, 316, 2025

Vaglio S, 2017, The Italian regulatory guidelines for the implementation of patient blood management, Blood Transfusion, 15, 325

Crosby L, 1994, Iron supplementation for acute blood loss anemia after coronary artery bypass surgery: a randomized, placebo‐controlled study, Heart and Lung, 23, 493

10.1302/0301-620X.86B1.13936

10.1111/j.1445-1433.2004.03265.x

10.1302/0301-620X.87B2.15122

10.1001/jama.1992.03480040073033

10.1016/j.injury.2009.02.021

10.2106/JBJS.I.00883

10.1053/j.jvca.2003.10.012

10.1007/BF03021522

10.1097/TP.0b013e318248375a

10.1007/s00268-012-1589-x

10.1093/icvts/ivs344

10.1245/s10434-013-3238-5

Muñoz M, 2017, Current misconceptions in diagnosis and management of iron deficiency, Blood Transfusion, 15, 422

10.1016/S0140-6736(07)60689-8

10.1016/j.mayocp.2014.10.007

European Medicines Agency.New recommendations to manage risk of allergic reactions with intravenous iron containing medicines. EMA/579491/2013.http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/IV_iron_31/WC500151308.pdf(accessed: 18/06/2017).

10.3324/haematol.2014.121004

10.1111/bph.13268

10.1016/j.kint.2015.10.002

10.3324/haematol.2014.111492

10.1016/j.coi.2009.01.011

10.1016/S0168-6445(03)00055-X

10.1111/ejh.12645

10.1002/ajh.24461

10.1136/bjsports-2014-093624

10.1111/j.1423-0410.2010.01427.x

10.1182/blood-2011-04-346304

10.1056/NEJMoa0908355

10.1002/ejhf.473

10.1002/ajh.24595

10.1177/0148607188012003282

10.1097/EJA.0b013e32834ad97b

10.1111/anae.14115

10.1093/bja/aeq361

10.1097/MIB.0b013e318281f4db

10.1002/ajh.22262

10.1111/jcpt.12218

10.1111/ane.12657

10.1097/SLA.0000000000001746

10.1016/j.hlc.2016.04.016

10.1007/s00508-016-1063-0

10.1111/trf.13027

10.1111/j.1537-2995.2006.00859.x

10.1111/trf.13624

10.1111/j.1423-0410.2009.01200.x

10.1111/trf.13750

10.1097/SLA.0000000000001747

10.1111/trf.12445

10.1111/trf.12946

Franchini M, 2017, Red blood cell transfusion policy: a critical literature review, Blood Transfusion, 15, 307

10.1016/j.tmrv.2010.11.001

10.1097/CCM.0000000000000548

10.1016/j.amjmed.2013.09.017

Brunskill SJ, 2015, Red blood cell transfusion for people undergoing hip fracture surgery, Cochrane Database of Systematic Reviews, 4, CD009699

10.1136/bmj.h1354

Ripollés Melchor J, 2016, Restrictive versus liberal transfusion strategy for red blood cell transfusion in critically ill patients and in patients with acute coronary syndrome: s systematic review, meta‐analysis and trial sequential analysis, Minerva Anestesiologica, 82, 582

Carson JL, 2016, Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion, Cochrane Database of Systematic Reviews, 10, CD002042

Liumbruno GM, 2016, Transfusion thresholds and beyond, Blood Transfusion, 14, 123

10.1097/ALN.0000000000000511

10.1097/CCM.0000000000002283

Shander A, 2013, A new perspective on best transfusion practices, Blood Transfusion, 11, 193

10.1111/anae.13304

10.1007/s00101-016-0152-9

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Anaesthesia

Tập 73 Số 11

1418-1431

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