Anaemia in cardiac surgery – a retrospective review of a centre's experience with a pre‐operative intravenous iron clinic

Anaesthesia - Tập 76 Số 5 - Trang 629-638 - 2021
Clare Quarterman1, Matthew Shaw2, Susan Hughes2, Valerie A. Wallace2, Seema Agarwal3
1Department of Anaesthesia, Liverpool Heart and Chest Hospital, UK
2Liverpool Heart and Chest Hospital, UK
3Department of Anaesthesia, Manchester University NHS Foundation Trust, UK

Tóm tắt

SummaryPre‐operative anaemia is associated with higher rates of transfusion and worse outcomes, including prolonged hospital stay, morbidity and mortality. Iron deficiency is associated with significantly lower haemoglobin levels throughout the peri‐operative period and more frequent blood transfusion. Correction of iron stores before surgery forms part of the first pillar of patient blood management. We established a pre‐operative anaemia clinic to aid identification and treatment of patients with iron deficiency anaemia scheduled for elective cardiac surgery. We present a retrospective observational review of our experience from January 2017 to December 2019. One‐hundred and ninety patients received treatment with intravenous iron, a median of 21 days before cardiac surgery. Of these, 179 had a formal laboratory haemoglobin level measured before surgery, demonstrating a median rise in haemoglobin of 8.0 g.l‐1. Patients treated with i.v. iron demonstrated a significantly higher incidence of transfusion (60%) compared with the non‐anaemic cohort (22%) during the same time period, p < 0.001. Significantly higher rates of new requirement for renal replacement therapy (6.7% vs. 0.6%, p < 0.001) and of stroke (3.7% vs. 1.2%, p = 0.010) were also seen in this group compared with those without anaemia, although there was no significant difference in in‐hospital mortality (1.6% vs. 0.8%, p = 0.230). In patients where the presenting haemoglobin was less than 130 g.l‐1, but there was no intervention or treatment, there was no difference in rates of transfusion or of complications compared with the anaemic group treated with iron. In patients with proven iron deficiency anaemia, supplementation with intravenous iron showed only a modest effect on haemoglobin and this group still had a significantly higher transfusion requirement than the non‐anaemic cohort. Supplementation with intravenous iron did not improve outcomes compared with patients with anaemia who did not receive intravenous iron and did not reduce peri‐operative risk to non‐anaemic levels. Questions remain regarding identification of patients who will receive most benefit, the use of concomitant treatment with other agents, and the optimum time frames for treatment in order to produce benefit in the real‐world setting.

Từ khóa


Tài liệu tham khảo

World Health Organization.Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia.2008.https://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_data_status_t2/en(accessed February 2020).

10.1111/anae.13423

10.1161/CIRCULATIONAHA.107.718353

10.1186/1749-8090-9-137

10.1111/j.1365-2044.2011.06819.x

10.1016/j.athoracsur.2019.04.044

10.1016/j.athoracsur.2012.04.042

10.1016/j.athoracsur.2013.07.020

10.1213/ANE.0000000000004528

10.1053/j.jvca.2019.02.006

10.1016/j.jtcvs.2018.03.109

10.1111/anae.13773

National Institute for Health and Care Excellence.Blood transfusion [NG24].2015.https://www.nice.org.uk/guidance/ng24(accessed February 2020).

10.1097/SLA.0000000000003095

10.1111/vox.12873

Kleinerüschkamp A, 2019, A model‐based cost‐effectiveness analysis of patient blood management, Blood Transfusion, 17, 16

10.1016/j.bja.2020.04.087

10.1016/j.bja.2019.11.023

10.1182/blood-2018-06-815894

10.1186/s40560-018-0328-2

10.1177/000456328101800405

10.1111/j.1471-0528.2006.01062.x

10.1016/S0140-6736(18)32555-8

Auerbach M, 2014, Safety of intravenous iron formulations: facts and folklore, Blood Transfusion, 12, 296

10.1007/s12185-017-2366-2

10.1530/EDM-19-0065

10.1016/j.bja.2019.09.016

European Society of Cardiology, 2016, Acute and chronic heart failure guidelines, European Heart Journal, 2016, 2129

10.1001/jama.2019.0554

10.1053/j.jvca.2017.06.026

Thông tin
Thông tin xuất bản

Anaesthesia

Tập 76 Số 5

629-638

Thông tin tác giả