PHARMACOLOGICAL MANAGEMENT OF PERIOPERATIVE ANAEMIA: OUR EXPERIENCE WITH INTRAVENOUS IRON IN ORTHOPAEDIC SURGERY
ISBT CONGRESS 2007
SETS CONGRESO 2007
PATIENT BLOOD MANAGEMENT
Ponencia ISBT-SETS Madrid 2007. IRON INTRAVENOUS AND SURGERY. Muñoz and Garcí...José Antonio García Erce
This document summarizes an experience using intravenous iron in orthopaedic surgery patients. It discusses using IV iron to treat preoperative anemia in both elective and non-elective orthopaedic procedures, such as hip fracture repair. The results showed IV iron reduced transfusion rates and helped optimize hemoglobin levels in the perioperative period. It concludes that IV iron administration may be suggested for patients undergoing orthopedic surgery expected to develop severe postoperative anemia.
Multicenter prospective study in several Spaniard hospital
Anemia and iron deficit in preoperative study
Presented at NATA meeting at Dublin, April 2016
Curso de actualización en patient blood management. Taller CASTYM (Control Avanzado del Sangrado en Trauma y Cirugía Mayor). 2ª Edición
CURSOS EXTRAORDINARIOS UNIVERSIDAD DE ZARAGOZA. Jaca, Julio 2017
Evolution of blood transfusion in Hospital General San Jorge
Change in blood consume during ten years.
Red cell concentrate, platelets and plasma reduction is possible
Patient Blood Management and Transfusion with common sense
PATIENT BLOOD MANAGEMENT Dr García Erce Mediterranean Anaemia Course4th cong...José Antonio García Erce
This document discusses strategies and protocols for optimizing hemoglobin levels in patients, known as "patient blood management". It begins by noting the high prevalence and risks of anemia. It then discusses how preoperative anemia increases risks like blood transfusions, complications, and mortality. The need for multimodal, multidisciplinary perioperative programs to improve anemia management via optimization of erythropoiesis, minimizing blood loss, and increasing anemia tolerance is discussed. Recommendations include testing hemoglobin and iron status at least 28 days before elective high-risk surgeries for patients over 60. The document emphasizes establishing evidence-based best practices and guidelines to improve patient outcomes through better anemia and blood management.
This document discusses strategies and protocols for optimizing hemoglobin levels in patients through patient blood management. It begins by outlining the high rates of preoperative anemia seen in various surgical specialties, from 25% to over 50% depending on the procedure. Preoperative anemia is associated with increased risks of mortality, morbidity, length of hospital stay, blood transfusions, and healthcare costs. The document emphasizes the importance of treating preoperative anemia to improve surgical outcomes and lower transfusion rates. It promotes the use of patient blood management strategies that include early anemia screening and treatment, as well as alternatives to allogeneic blood transfusions when possible.
This document discusses patient blood management (PBM), which is a multidisciplinary approach to optimizing patient care and reducing unnecessary blood transfusions. It has three pillars: optimizing erythropoiesis, minimizing bleeding, and harnessing physiological reserves of anemia. The evidence shows PBM can reduce transfusions by 39% without increasing risks. It has led to reduced transfusions and costs in various settings like cardiac and orthopedic surgery. PBM programs require a multidisciplinary team approach led by specialties like anesthesiology. Overall, PBM provides better patient outcomes while reducing allogeneic blood use.
This document discusses the relationship between iron deficiency, anemia, and quality of life in patients with chronic heart failure. It presents results from a study of 552 chronic heart failure patients which found that those with iron deficiency had significantly worse health-related quality of life scores compared to those without iron deficiency, regardless of their anemia status. Iron deficiency was defined as serum ferritin levels <100 ng/mL or serum ferritin <800 ng/mL with transferrin saturation <20%. This suggests that iron deficiency is a key determinant of poorer quality of life in chronic heart failure patients over and above any effects of anemia.
Ponencia ISBT-SETS Madrid 2007. IRON INTRAVENOUS AND SURGERY. Muñoz and Garcí...José Antonio García Erce
This document summarizes an experience using intravenous iron in orthopaedic surgery patients. It discusses using IV iron to treat preoperative anemia in both elective and non-elective orthopaedic procedures, such as hip fracture repair. The results showed IV iron reduced transfusion rates and helped optimize hemoglobin levels in the perioperative period. It concludes that IV iron administration may be suggested for patients undergoing orthopedic surgery expected to develop severe postoperative anemia.
Multicenter prospective study in several Spaniard hospital
Anemia and iron deficit in preoperative study
Presented at NATA meeting at Dublin, April 2016
Curso de actualización en patient blood management. Taller CASTYM (Control Avanzado del Sangrado en Trauma y Cirugía Mayor). 2ª Edición
CURSOS EXTRAORDINARIOS UNIVERSIDAD DE ZARAGOZA. Jaca, Julio 2017
Evolution of blood transfusion in Hospital General San Jorge
Change in blood consume during ten years.
Red cell concentrate, platelets and plasma reduction is possible
Patient Blood Management and Transfusion with common sense
PATIENT BLOOD MANAGEMENT Dr García Erce Mediterranean Anaemia Course4th cong...José Antonio García Erce
This document discusses strategies and protocols for optimizing hemoglobin levels in patients, known as "patient blood management". It begins by noting the high prevalence and risks of anemia. It then discusses how preoperative anemia increases risks like blood transfusions, complications, and mortality. The need for multimodal, multidisciplinary perioperative programs to improve anemia management via optimization of erythropoiesis, minimizing blood loss, and increasing anemia tolerance is discussed. Recommendations include testing hemoglobin and iron status at least 28 days before elective high-risk surgeries for patients over 60. The document emphasizes establishing evidence-based best practices and guidelines to improve patient outcomes through better anemia and blood management.
This document discusses strategies and protocols for optimizing hemoglobin levels in patients through patient blood management. It begins by outlining the high rates of preoperative anemia seen in various surgical specialties, from 25% to over 50% depending on the procedure. Preoperative anemia is associated with increased risks of mortality, morbidity, length of hospital stay, blood transfusions, and healthcare costs. The document emphasizes the importance of treating preoperative anemia to improve surgical outcomes and lower transfusion rates. It promotes the use of patient blood management strategies that include early anemia screening and treatment, as well as alternatives to allogeneic blood transfusions when possible.
This document discusses patient blood management (PBM), which is a multidisciplinary approach to optimizing patient care and reducing unnecessary blood transfusions. It has three pillars: optimizing erythropoiesis, minimizing bleeding, and harnessing physiological reserves of anemia. The evidence shows PBM can reduce transfusions by 39% without increasing risks. It has led to reduced transfusions and costs in various settings like cardiac and orthopedic surgery. PBM programs require a multidisciplinary team approach led by specialties like anesthesiology. Overall, PBM provides better patient outcomes while reducing allogeneic blood use.
This document discusses the relationship between iron deficiency, anemia, and quality of life in patients with chronic heart failure. It presents results from a study of 552 chronic heart failure patients which found that those with iron deficiency had significantly worse health-related quality of life scores compared to those without iron deficiency, regardless of their anemia status. Iron deficiency was defined as serum ferritin levels <100 ng/mL or serum ferritin <800 ng/mL with transferrin saturation <20%. This suggests that iron deficiency is a key determinant of poorer quality of life in chronic heart failure patients over and above any effects of anemia.
1) The AURA OF ARTEMIS study was a randomized trial comparing transulnar versus transradial arterial access as the default strategy for coronary procedures.
2) In the interim analysis, the composite primary endpoint was significantly higher in the ulnar arm compared to the radial arm, with a 24.3% difference between arms. The study was terminated early due to the inferiority of the transulnar approach.
3) Complications associated with the transulnar approach included pseudoaneurysms, perforations, occlusions and arteriovenous fistulas. Crossover from ulnar to other access sites was also more common.
CRTP ou CRTD? Quels arguments pour notre choix? (Pr C. Leclercq)Brussels Heart Center
1) Studies have shown that 35-50% of deaths in heart failure patients are due to sudden cardiac death.
2) Medical treatments like ACE inhibitors, beta-blockers, and aldosterone antagonists can reduce mortality in heart failure patients, but their effect on sudden cardiac death is limited.
3) Guidelines do not make strict recommendations for CRT-D vs CRT-P, preferring to offer guidance based on clinical condition, device complications, and cost. The document discusses factors to consider for individual patients.
The effective national primary angioplasty network. Petr WidimskýChaichuk Sergiy
The document discusses lessons learned from effective primary angioplasty networks in 5 European countries. It finds that regional networks covering 500,000-1,000,000 people, 24/7 primary PCI services, and bypassing nearest hospitals to limit delays are optimal. Direct transport to the cath lab without going through the emergency room can achieve under 90 minute door-to-balloon times in most patients.
This document discusses anticoagulation options for coronary procedures. Unfractionated heparin (UFH) is the most cost-effective option. The goals of anticoagulation are to prevent radial artery occlusion after angiography, avoid complications like stent thrombosis during percutaneous coronary intervention (PCI), and reduce bleeding. UFH 5000 IU is effective for preventing radial occlusion after angiography. For planned PCI, STEMI, or NSTEMI, UFH or low molecular weight heparin are first-line options, though bivalirudin reduces bleeding. The benefit of bivalirudin may be mitigated for radial procedures and its high cost is a limitation. More data is needed on anticoagulant
Структура «Реперфузионной Сети» Чешской Республики. Первичное стентирование д...Chaichuk Sergiy
The document proposes new certification requirements for interventional cardiologists in the Czech Republic based on European models. It recommends interventional cardiology become a certified subspecialty after completing cardiology training. The proposed requirements include 1 year of full-time interventional cardiology training, courses, publications, and a final board exam. Accredited centers must have experienced trainers, cath labs, ICU, and imaging. Up to 100 experienced interventional cardiologists could be initially certified without the exam to start the program.
Enhancing Limb Salvage by Non-Mobilized Peripheral Blood Angiogenic Cell Prec...lifextechnologies
This document describes a study that assessed the efficacy and safety of implanting non-mobilized peripheral blood angiogenic cell precursors (NMPB-ACPs) in 6 patients with critical limb ischemia who were not candidates for standard revascularization treatments. The results showed no complications from the procedure. Five patients (83.3%) had improved circulation in the distal limb, with complete healing of ulcers/amputation sites. However, one patient later required an amputation due to foot infection. The preliminary results suggest NMPB-ACPs therapy may be safe and improve circulation, but a larger controlled trial is needed to confirm these findings.
This document discusses athlete's heart and the use of echocardiography in evaluating it. It notes that intense dynamic training can cause eccentric hypertrophy while intense isometric training causes concentric hypertrophy. It references several studies on using new echocardiography techniques to differentiate physiological cardiac remodeling in athletes from pathology. One study found 4D strain imaging useful to identify subtle abnormalities. Other studies examined global longitudinal strain for assessing athlete's heart and the role of cardiac biomarkers to improve diagnosis. The document provides an overview of research on evaluating cardiac changes in athletes using echocardiography.
- CVD affects a large portion of the global adult population and poses a significant socioeconomic burden due to costs of treatment, lost work days, and reduced quality of life.
- Both physician-reported signs and patient-reported symptoms increase in prevalence and severity as CVD progresses through higher CEAP classes.
- Standardized instruments like the CIVIQ and VCSS are used to evaluate treatment effectiveness on symptoms and quality of life from both the physician and patient perspectives.
- Studies show quality of life is significantly reduced in patients with CVD, being similar to the impairment caused by severe conditions like cancer, diabetes, and heart failure. Quality of life also decreases with greater number of symptoms and higher CEAP class.
The document discusses options for difficult forearm arteriovenous fistula (AVF) access for hemodialysis. It describes using basilic or cephalic vein transposition in the forearm when wrist AVF is not available or has failed. The author presents case studies and results from 82 patients who underwent basilic or cephalic vein transposition, finding 96% primary patency and 87% secondary patency after a mean follow up of 32.5 months. Complications occurred in 17% of cases and were mostly treated conservatively without loss of the fistula. The conclusions emphasize that autogenous AVF using transposed forearm veins can provide good patency and should be emphasized for long-term hemod
Eversion or standard carotid endarterectomy local or general anesthesia does ...uvcd
1) This document discusses different techniques for carotid endarterectomy (CEA), including eversion endarterectomy (EEA) versus standard CEA with patchplasty, and whether general (GA) or local anesthesia (LA) makes a difference.
2) Meta-analyses and randomized trials like the GALA trial found no significant differences in stroke or death rates between EEA versus CEA, or between GA versus LA.
3) The conclusions are that the choice of surgical technique and anesthesia method depends on surgeon and patient factors, with completion imaging advisable, but overall the scientific evidence shows no difference in outcomes between the various options.
Radial access for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients reduces bleeding complications compared to femoral access. Several randomized controlled trials showed lower all-cause mortality with radial versus femoral access when performed by experienced radial operators. However, the studies only included radial operators, so it is unclear if the benefits seen with radial access would apply if femoral operators performed radial procedures or vice versa. Additionally, radial access requires experienced operators at high-volume centers, and the definition of an experienced radial operator remains uncertain due to the steep learning curve for radial procedures. The primary goal of primary PCI in STEMI is restoring blood flow to the heart, not avoiding access site complications.
Rotational atherectomy can be performed via the radial or femoral artery approaches with similar success rates. A study compared outcomes of 67 patients who underwent rotational atherectomy via the femoral approach to 52 patients who underwent it via the radial approach and found no significant differences in procedural characteristics, success rates, or in-hospital complications between the two groups except that pacing wires were inserted less often in the radial group. Overall, rotational atherectomy performed via the radial approach was found to be a feasible alternative to the femoral approach.
Rotational atherectomy may provide benefits over plain balloon angioplasty for treating severely calcified coronary lesions. It allows for more effective preparation and debulking of hard plaque, enabling better stent expansion and apposition. However, studies comparing rotational atherectomy plus drug-eluting stent versus plain angioplasty plus drug-eluting stent have shown inconsistent results, with no clear evidence that rotational atherectomy improves long-term outcomes in the drug-eluting stent era. Further research is still needed to determine whether current generation drug-eluting stents achieve similar results with or without preceding rotational atherectomy for complex lesion subsets.
This document summarizes the career and research of Dr. Eulogio García focusing on primary angioplasty for acute myocardial infarction. It details his early work in the 1990s establishing primary angioplasty programs in Spain and conducting randomized trials comparing it to thrombolysis. It describes his later involvement in large international multicenter trials that helped establish best practices in primary angioplasty and demonstrated benefits in subgroups. The document outlines over 150 publications and highlights his role in increasing acceptance of primary angioplasty in clinical guidelines.
The document summarizes guidelines from the 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. It discusses recommendations for various preoperative, intraoperative, and postoperative interventions to reduce blood loss and transfusions during cardiac procedures. The guidelines classify recommendations into different evidence-based classes and assign levels of evidence. Areas addressed include management of antiplatelet drugs, use of blood derivatives, minimally invasive procedures, blood salvage techniques, and creation of multidisciplinary blood management teams.
The document discusses bleeding as a complication of percutaneous coronary intervention (PCI) and antiplatelet therapy, noting that bleeding is associated with significantly increased mortality and morbidity, and that assessing bleeding risk, optimizing vascular access through the radial approach, and tailoring antiplatelet treatment can help address this problem. Major causes of bleeding include access site complications and prolonged dual antiplatelet therapy beyond 6 months without clear benefits.
FARMACOLOGÍA Y TRATAMIENTO DE LA ANEMIA PERIOPERATORIA. HIERRO, EPOR, ANDRÓGENOS, ANTIHEPCIDINA
PRIMER PILAR PATIENT BLOOD TRANSFUSIÓN
“Curso de actualización en patient blood management”. Taller CASTYM (Control Avanzado del Sangrado en Trauma y Cirugía Mayor)
CURSOS EXTRAORDINARIOS UNIVERSIDAD DE ZARAGOZA
This document discusses animation concepts and tools. It defines animation as giving life to objects that cannot move on their own by specifying their movement over time. The history of animation is traced from early experiments in the 19th century to modern computer animation. Types of animation include procedural, representation, stochastic, behavioral, 2D and 3D. Traditional animation methods like key frames, cel animation and rotoscoping are described. Computer animation techniques include key framing, motion capture and simulation. Popular hardware used includes SGI, PCs and Macintosh. Software tools discussed are 3D Studio Max, LightWave3D, Adobe Premiere, Alias/Wavefront, Animator Studio and Elastic Reality.
1) The AURA OF ARTEMIS study was a randomized trial comparing transulnar versus transradial arterial access as the default strategy for coronary procedures.
2) In the interim analysis, the composite primary endpoint was significantly higher in the ulnar arm compared to the radial arm, with a 24.3% difference between arms. The study was terminated early due to the inferiority of the transulnar approach.
3) Complications associated with the transulnar approach included pseudoaneurysms, perforations, occlusions and arteriovenous fistulas. Crossover from ulnar to other access sites was also more common.
CRTP ou CRTD? Quels arguments pour notre choix? (Pr C. Leclercq)Brussels Heart Center
1) Studies have shown that 35-50% of deaths in heart failure patients are due to sudden cardiac death.
2) Medical treatments like ACE inhibitors, beta-blockers, and aldosterone antagonists can reduce mortality in heart failure patients, but their effect on sudden cardiac death is limited.
3) Guidelines do not make strict recommendations for CRT-D vs CRT-P, preferring to offer guidance based on clinical condition, device complications, and cost. The document discusses factors to consider for individual patients.
The effective national primary angioplasty network. Petr WidimskýChaichuk Sergiy
The document discusses lessons learned from effective primary angioplasty networks in 5 European countries. It finds that regional networks covering 500,000-1,000,000 people, 24/7 primary PCI services, and bypassing nearest hospitals to limit delays are optimal. Direct transport to the cath lab without going through the emergency room can achieve under 90 minute door-to-balloon times in most patients.
This document discusses anticoagulation options for coronary procedures. Unfractionated heparin (UFH) is the most cost-effective option. The goals of anticoagulation are to prevent radial artery occlusion after angiography, avoid complications like stent thrombosis during percutaneous coronary intervention (PCI), and reduce bleeding. UFH 5000 IU is effective for preventing radial occlusion after angiography. For planned PCI, STEMI, or NSTEMI, UFH or low molecular weight heparin are first-line options, though bivalirudin reduces bleeding. The benefit of bivalirudin may be mitigated for radial procedures and its high cost is a limitation. More data is needed on anticoagulant
Структура «Реперфузионной Сети» Чешской Республики. Первичное стентирование д...Chaichuk Sergiy
The document proposes new certification requirements for interventional cardiologists in the Czech Republic based on European models. It recommends interventional cardiology become a certified subspecialty after completing cardiology training. The proposed requirements include 1 year of full-time interventional cardiology training, courses, publications, and a final board exam. Accredited centers must have experienced trainers, cath labs, ICU, and imaging. Up to 100 experienced interventional cardiologists could be initially certified without the exam to start the program.
Enhancing Limb Salvage by Non-Mobilized Peripheral Blood Angiogenic Cell Prec...lifextechnologies
This document describes a study that assessed the efficacy and safety of implanting non-mobilized peripheral blood angiogenic cell precursors (NMPB-ACPs) in 6 patients with critical limb ischemia who were not candidates for standard revascularization treatments. The results showed no complications from the procedure. Five patients (83.3%) had improved circulation in the distal limb, with complete healing of ulcers/amputation sites. However, one patient later required an amputation due to foot infection. The preliminary results suggest NMPB-ACPs therapy may be safe and improve circulation, but a larger controlled trial is needed to confirm these findings.
This document discusses athlete's heart and the use of echocardiography in evaluating it. It notes that intense dynamic training can cause eccentric hypertrophy while intense isometric training causes concentric hypertrophy. It references several studies on using new echocardiography techniques to differentiate physiological cardiac remodeling in athletes from pathology. One study found 4D strain imaging useful to identify subtle abnormalities. Other studies examined global longitudinal strain for assessing athlete's heart and the role of cardiac biomarkers to improve diagnosis. The document provides an overview of research on evaluating cardiac changes in athletes using echocardiography.
- CVD affects a large portion of the global adult population and poses a significant socioeconomic burden due to costs of treatment, lost work days, and reduced quality of life.
- Both physician-reported signs and patient-reported symptoms increase in prevalence and severity as CVD progresses through higher CEAP classes.
- Standardized instruments like the CIVIQ and VCSS are used to evaluate treatment effectiveness on symptoms and quality of life from both the physician and patient perspectives.
- Studies show quality of life is significantly reduced in patients with CVD, being similar to the impairment caused by severe conditions like cancer, diabetes, and heart failure. Quality of life also decreases with greater number of symptoms and higher CEAP class.
The document discusses options for difficult forearm arteriovenous fistula (AVF) access for hemodialysis. It describes using basilic or cephalic vein transposition in the forearm when wrist AVF is not available or has failed. The author presents case studies and results from 82 patients who underwent basilic or cephalic vein transposition, finding 96% primary patency and 87% secondary patency after a mean follow up of 32.5 months. Complications occurred in 17% of cases and were mostly treated conservatively without loss of the fistula. The conclusions emphasize that autogenous AVF using transposed forearm veins can provide good patency and should be emphasized for long-term hemod
Eversion or standard carotid endarterectomy local or general anesthesia does ...uvcd
1) This document discusses different techniques for carotid endarterectomy (CEA), including eversion endarterectomy (EEA) versus standard CEA with patchplasty, and whether general (GA) or local anesthesia (LA) makes a difference.
2) Meta-analyses and randomized trials like the GALA trial found no significant differences in stroke or death rates between EEA versus CEA, or between GA versus LA.
3) The conclusions are that the choice of surgical technique and anesthesia method depends on surgeon and patient factors, with completion imaging advisable, but overall the scientific evidence shows no difference in outcomes between the various options.
Radial access for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients reduces bleeding complications compared to femoral access. Several randomized controlled trials showed lower all-cause mortality with radial versus femoral access when performed by experienced radial operators. However, the studies only included radial operators, so it is unclear if the benefits seen with radial access would apply if femoral operators performed radial procedures or vice versa. Additionally, radial access requires experienced operators at high-volume centers, and the definition of an experienced radial operator remains uncertain due to the steep learning curve for radial procedures. The primary goal of primary PCI in STEMI is restoring blood flow to the heart, not avoiding access site complications.
Rotational atherectomy can be performed via the radial or femoral artery approaches with similar success rates. A study compared outcomes of 67 patients who underwent rotational atherectomy via the femoral approach to 52 patients who underwent it via the radial approach and found no significant differences in procedural characteristics, success rates, or in-hospital complications between the two groups except that pacing wires were inserted less often in the radial group. Overall, rotational atherectomy performed via the radial approach was found to be a feasible alternative to the femoral approach.
Rotational atherectomy may provide benefits over plain balloon angioplasty for treating severely calcified coronary lesions. It allows for more effective preparation and debulking of hard plaque, enabling better stent expansion and apposition. However, studies comparing rotational atherectomy plus drug-eluting stent versus plain angioplasty plus drug-eluting stent have shown inconsistent results, with no clear evidence that rotational atherectomy improves long-term outcomes in the drug-eluting stent era. Further research is still needed to determine whether current generation drug-eluting stents achieve similar results with or without preceding rotational atherectomy for complex lesion subsets.
This document summarizes the career and research of Dr. Eulogio García focusing on primary angioplasty for acute myocardial infarction. It details his early work in the 1990s establishing primary angioplasty programs in Spain and conducting randomized trials comparing it to thrombolysis. It describes his later involvement in large international multicenter trials that helped establish best practices in primary angioplasty and demonstrated benefits in subgroups. The document outlines over 150 publications and highlights his role in increasing acceptance of primary angioplasty in clinical guidelines.
The document summarizes guidelines from the 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. It discusses recommendations for various preoperative, intraoperative, and postoperative interventions to reduce blood loss and transfusions during cardiac procedures. The guidelines classify recommendations into different evidence-based classes and assign levels of evidence. Areas addressed include management of antiplatelet drugs, use of blood derivatives, minimally invasive procedures, blood salvage techniques, and creation of multidisciplinary blood management teams.
The document discusses bleeding as a complication of percutaneous coronary intervention (PCI) and antiplatelet therapy, noting that bleeding is associated with significantly increased mortality and morbidity, and that assessing bleeding risk, optimizing vascular access through the radial approach, and tailoring antiplatelet treatment can help address this problem. Major causes of bleeding include access site complications and prolonged dual antiplatelet therapy beyond 6 months without clear benefits.
FARMACOLOGÍA Y TRATAMIENTO DE LA ANEMIA PERIOPERATORIA. HIERRO, EPOR, ANDRÓGENOS, ANTIHEPCIDINA
PRIMER PILAR PATIENT BLOOD TRANSFUSIÓN
“Curso de actualización en patient blood management”. Taller CASTYM (Control Avanzado del Sangrado en Trauma y Cirugía Mayor)
CURSOS EXTRAORDINARIOS UNIVERSIDAD DE ZARAGOZA
This document discusses animation concepts and tools. It defines animation as giving life to objects that cannot move on their own by specifying their movement over time. The history of animation is traced from early experiments in the 19th century to modern computer animation. Types of animation include procedural, representation, stochastic, behavioral, 2D and 3D. Traditional animation methods like key frames, cel animation and rotoscoping are described. Computer animation techniques include key framing, motion capture and simulation. Popular hardware used includes SGI, PCs and Macintosh. Software tools discussed are 3D Studio Max, LightWave3D, Adobe Premiere, Alias/Wavefront, Animator Studio and Elastic Reality.
Blue Bird uni-coat plaster is a gypsum-based plaster that is manufactured from pure calcium sulfate obtained from mines. It is finely ground and treated at high temperatures before hardening compounds are added. The plaster exhibits high strength, low shrinkage, thermal insulation, and sound absorption properties. It can be applied in a single coat on walls and ceilings, offering faster application compared to cement plaster. Blue Bird plaster is environmentally friendly and poses no health hazards.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like depression and anxiety.
Este documento describe el proceso de motivación en 3 oraciones:
1) La motivación es un proceso dinámico que implica la interacción entre un individuo y su entorno para iniciar y dirigir la conducta hacia metas particulares.
2) El proceso de motivación incluye la percepción de estímulos, la evaluación de los mismos, la selección de metas, la decisión de actuar y el control del resultado de la conducta.
3) La motivación tiene componentes biológicos, de aprendizaje y cognitivos que interact
This document contains 30 multiple choice questions related to mathematics. It includes questions about topics like probability, geometry, polynomials, lines and angles. The document provides the questions, possible answer options for each question, and blank space for the student to fill in their answers. It also provides identifying information for the student, including their name, class, roll number and school.
The document discusses the benefits of meditation for reducing stress and anxiety. Regular meditation practice can help calm the mind and body by lowering heart rate and blood pressure. Studies have shown that meditating for just 10-20 minutes per day can have significant positive impacts on both mental and physical health.
This document outlines the course structure for an Information Technology NVEQ program at levels 3 and 4. At level 3, students take two papers focusing on IT tools, office automation, networking, multimedia design, and web applications. Level 4 includes two papers on data management applications, web-based applications, fundamentals of Java programming, and movie editing tools for embedding multimedia in web pages. Each unit includes topics covered and hours allocated. The program aims to provide both knowledge and practical skills in various IT domains.
This document provides information about the IT Level 3: IT Tools Class XI student handbook published by the Central Board of Secondary Education in India. It was developed by experts in consultation with industry representatives to provide competency-based vocational education in information technology. The handbook aims to use simple language and include illustrations to help students understand concepts. It contains 6 units that cover topics like computer hardware, operating systems, networking, internet safety, office automation tools, multimedia design, troubleshooting, and work-integrated learning in IT. The board acknowledges the contribution of practicing IT professionals and academic advisors in developing this resource for students.
Information Technology (IX CLASS FIRST TERM) Adityaroy110
This document provides an introduction to a student handbook on fundamentals of computers. It outlines the contents of the handbook which covers 11 sessions on basic computer concepts such as introduction to computers, parts of a computer system, types of computers, operating systems, file operations, the internet, world wide web, digital technology and computer security. The handbook aims to develop relevant knowledge and skills through exercises and assessments in each session. It acknowledges contributions from various partners who provided content for the handbook.
Medidas farmacológicas para la reducción del sangrado. Antifibrinolíticos....José Antonio García Erce
Medidas farmacológicas para la reducción del sangrado. Antifibrinolíticos. Tranexámico. “Curso de actualización en patient blood management”. Taller CASTYM (Control Avanzado del Sangrado en Trauma y Cirugía Mayor). Universidad de Zaragoza. Curso de Verano, Jaca 2016
“Curso de actualización en patient blood management”. Taller CASTYM (Control Avanzado del Sangrado en Trauma y Cirugía Mayor). CURSOS EXTRAORDINARIOS UNIVERSIDAD DE ZARAGOZA, Jaca, Julio 2016
Pbm. iron therapy in surgery practice. dr garcia erce. harrogate september 2014José Antonio García Erce
BRITISH TRANSFUSION SOCIETY CONGRESS 2014
PATIENT BLOOD MANAGEMENT SESSION
IRON THERAPY IN SURGERY PRACTICE
PERIOPERATIVE ANEMIA TREATMENT
BLOODLESS MEDICINE
Anemo 2010 - Inghilleri - Anemie preoperatorie valutazione e trattamentoanemo_site
This document summarizes guidelines for evaluating and treating preoperative anemia. It finds that preoperative hemoglobin level is the strongest predictor of blood transfusion need after surgery. Guidelines recommend determining hemoglobin levels for elective surgery patients around 28 days before the procedure. Treatment for preoperative anemia depends on the underlying cause, and may include oral or intravenous iron, erythropoietin stimulating agents, or addressing nutritional deficiencies. The goal is to optimize hemoglobin levels before elective surgery to reduce the risk of blood transfusions.
This document summarizes a workshop on the treatment of pre-operative and post-operative anemia and whether transfusion is necessary. It discusses that 30-50% of surgical patients may have pre-operative anemia from various causes, and up to 90% may develop post-operative anemia due to blood loss or inhibited erythropoiesis. The presence of anemia in surgical patients is correlated with increased post-operative morbidity and mortality and decreased quality of life. The workshop then covers topics like the incidence and etiology of pre-operative anemia, relationship between pre-operative hemoglobin levels and transfusion risk, impact of transfusion on post-operative complications and mortality, and approaches to patient blood management including optim
INTRODUCCIÓN AL PATIENT BLOOD MANAGEMENT. Conferencia Inagural. Prof HerreraJosé Antonio García Erce
Curso de actualización en patient blood management. Taller CASTYM (Control Avanzado del Sangrado en Trauma y Cirugía Mayor). 2ª Edición
CURSOS EXTRAORDINARIOS UNIVERSIDAD DE ZARAGOZA. Jaca 2017
Anemo 2014 - Infusino - Protocol anticoagulation in urologyanemo_site
1) The document discusses guidelines for bridging anticoagulation therapy for patients on vitamin K antagonists (VKAs) undergoing elective urological procedures.
2) It proposes a new protocol for patients undergoing ThuLEP which stratifies thromboembolic risk and minimizes or avoids bridging with low molecular weight heparin (LMWH).
3) Preliminary results from 5 patients managed under the new protocol found it was safe and allowed for shorter hospitalization without thromboembolic or bleeding complications compared to standard bridging therapy.
Integrated strategies for allogenic blood saving in major elective surgery ...anemo_site
This document discusses an integrated strategy implemented at a hospital in Rome, Italy since 2008 to reduce allogeneic blood transfusions for major elective surgeries. The strategy includes patient evaluation and supplementation if needed, along with autologous blood collection through pre-surgical donation or peri-surgical collection. Analysis of results from 2010 found that autologous unit usage increased 2.2 times, units not stored increased 2.4 times, and allogeneic unit transfusions were reduced by 65%, allowing for fresher blood transfusions to improve patient outcomes. The integrated strategy was more effective than previous practices at the hospital in conserving allogeneic blood supplies and reducing transfusion-related risks for patients.
Autologous blood transfusion /certified fixed orthodontic courses by Indian ...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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This document summarizes guidelines for thromboprophylaxis from the 7th ACCP conference. It discusses the rationale for thromboprophylaxis, including the high prevalence and adverse consequences of unprevented VTE. It outlines risk factors for VTE and basic principles of thromboprophylaxis. It provides recommendations for prophylaxis in different patient groups based on risk level, including for different surgical procedures. It discusses strategies to improve implementation of guidelines in clinical practice.
Intraoperative oesophageal Doppler monitoring (ODM) guided fluid management was compared to standard central venous pressure (CVP) guided fluids in a randomized controlled trial of 128 colorectal surgery patients. ODM guided fluid optimization resulted in significantly shorter hospital length of stay, earlier return of gut function, fewer postoperative complications, and cost savings compared to CVP-guided fluids. ODM provided a more reliable assessment of intravascular volume status and cardiac preload than CVP alone.
Oesophageal Doppler Monitoring (ODM) provides a non-invasive assessment of stroke volume and cardiac output during surgery. A randomized controlled trial found that using ODM to guide intraoperative fluid management in colorectal surgery patients resulted in shorter hospital length of stay, earlier return of gut function, fewer complications, better hemodynamic measurements, and cost savings compared to managing fluids to maintain CVP between 12-15 mmHg. ODM may help optimize fluid management and improve recovery in complex and orthopedic surgeries.
Transfusion support in Surgery- elective surgery, cardiac surgery, MSBOS, Tra...DrShinyKajal
AABB indications
Elective surgeries- Maximum surgical blood ordering schedule
Anemia and surgery- including Transfusion Trigger
Surgery and coagulation disorders- including factor replacement
Transfusion in cardiac surgeries- including autologous transfusion
Patient Blood management in surgery
Allogenic Transfusion
Autologous Transfusion- Intra And Postoperative Red Cell Salvage, Haemodilution
Blood Substitutes
Haematopoietic Factors
Antifibrinolytics
Fibrin Sealants
Conjugated Oestrogens.
AABB pretransfusion testing schemes
Type and screen
Maximum surgical blood ordering schedule
transfusion trigger for surgery
factor replacement in surgery
autologous transfusion
cell salvage
perioperative
massive transfusion protocol
1) The document provides an evidence-based approach to treating proximal femoral fractures, including classification, decision making, preoperative planning, and postoperative care.
2) Key aspects of preoperative planning discussed include thorough patient history, physical exam, imaging including x-rays and MRI, and consideration of patient comorbidities.
3) Postoperative guidelines recommend thromboprophylaxis including low molecular weight heparin, physical and occupational therapy, and treatment of osteoporosis to improve outcomes for hip fracture patients.
This document describes two case studies of patients who received pre-operative intravenous iron infusions for anemia prior to vascular surgery. Both patients had multiple comorbidities and underwent semi-elective or urgent procedures. In the first case, the patient's hemoglobin levels improved with IV iron treatment and she did not require blood transfusions. In the second case, the patient only needed one blood transfusion post-operatively after starting IV iron the day before surgery. The document calls for more studies on pre-operative anemia management in vascular patients to develop specific recommendations for this high-risk patient group.
Anemo 2015-18-Santagostino- Gestione perioperatoria del paziente emofilicoanemo_site
This document discusses perioperative management of patients with hemophilia undergoing surgery. It provides global survey data on bleeding disorder prevalence. It describes hemophilia classifications and diagnostic testing. Factor level targets and treatment methods like bolus dosing or continuous infusion are discussed for surgery in hemophilia patients without and with inhibitors. Considerations include comorbidities, thrombosis risk, and postoperative rehabilitation. The goal is safe surgical hemostasis and recovery for patients with hemophilia.
There are several alternatives to blood transfusion that can help reduce its use and risks. These include treating pre-existing anemia, using medications to stimulate red blood cell production or stop bleeding, employing blood-saving surgical techniques and technologies like cell salvage machines. While blood substitutes have been studied, none have gained approval due to safety issues. Implementing strategies of patient blood management can help minimize allogenic blood transfusions.
This document provides an evidence-based approach to the treatment of proximal femoral fractures. It begins with an introduction that defines proximal femoral fractures and their prevalence. It then discusses fracture classification systems and key factors for decision making regarding surgical treatment. The document outlines important considerations for preoperative planning, including patient evaluation, imaging, and guidelines. Postoperative protocols are covered, such as thromboprophylaxis, rehabilitation, and follow up care. Overall guidelines and evidence for an optimal approach to proximal femoral fractures are summarized from pre-operative planning through post-operative management.
1. The document provides an overview of transfusion medicine, including the procurement and processing of blood components, their clinical uses, adverse effects, and good transfusion practices.
2. Blood donations are screened and tested for infectious agents before being processed into components like red blood cells, platelets, and plasma. Compatibility must be ensured when selecting components for transfusion.
3. Key aspects of safe transfusion include properly identifying the patient, prescribing transfusions only when benefits outweigh risks, obtaining informed consent, and monitoring for adverse events during and after transfusion. Guidelines aim to optimize clinical outcomes while minimizing risks.
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Manejo de la ANEMIA Y DE LA FERROPENIA EN LA HEMORRAGIA DIGESTIVA
PROtocolos asistenciales para mejorar la GESTión interdisciplinar de las enfermedades DIGestivas en el ámbito hospitalario
Asociación Española de Gastroenterologia
Anemia en distintos contextos médico-quirúrgicos. Experiencias Clínicas:
Manejo de la Anemia y Déficit de hierro (III): en paciente urológica. Dr Oliva
1. El documento describe varias enfermedades poco frecuentes que predisponen a la trombosis como las neoplasias mieloproliferativas crónicas como la policitemia vera y la trombocitemia esencial que presentan un aumento de glóbulos rojos y plaquetas respectivamente.
2. Estas enfermedades comparten características como la sobreproducción de células sanguíneas, anomalías citogenéticas y diátesis trombótica.
3. El tratamiento se dirige a reducir
El documento presenta varios casos clínicos de pacientes. Brevemente describe los síntomas, diagnósticos y tratamientos de tres pacientes que acudieron a consulta médica con diferentes problemas de salud.
Lección inaugural: “Patient Blood Management: concepto, componentes e implementación” Prof A. Herrera
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Protocolos de Transfusión Masiva. Actualización en Hemorragia Masiva. Dr Páramo
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Manejo de la Anemia y Déficit de hierro (I): en paciente ortopédico.
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Conceptos y Generalidades de la Hemoterapia y Patient Blood Management.
Manejo de la Anemia y Déficit de hierro (IV): en la hemorragia digestiva. Dr Montoro
Anemia en distintos contextos médico-quirúrgicos. Experiencias Clínicas
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“Nuevas Pruebas”: Test de Generación de Trombina, Técnicas viscoelásticas, t...José Antonio García Erce
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Manejo perioperatorio del paciente anticoagulado/antiagregado. “Terapia puent...José Antonio García Erce
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Criterios “restrictivos” de transfusión de concentrados de hematíes. Dra AnteloJosé Antonio García Erce
Este documento discute criterios restrictivos para la transfusión de concentrados de hematíes. Presenta la fisiología de los glóbulos rojos y la anemia, aspectos legales de la transfusión, tipos de concentrados de hematíes, riesgos asociados a la transfusión como sobrecarga circulatoria y síndrome de dificultad respiratoria aguda relacionada con la transfusión, y nuevos algoritmos para determinar cuándo una transfusión es necesaria de forma segura y eficaz. El objetivo es mejorar la calidad de la at
Criterios, Indicación y alternativas a la transfusión de plasma y plasma
III Curso Castym-PBM
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Cursos Extraordinarios de Verano. Sede Jaca
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¿Esperando para una Hb mejor?
Manejo Anemia Perioperatoria
Conclusiones del Documento de Salamanca de la Rehabilitación Multimodal
http://www.germ2018.es
(1) El documento presenta novedades en la hemoterapia, incluyendo legislación, riesgos infecciosos, y técnicas como la inactivación de patógenos. (2) Revisa temas como la crisis de la oferta y demanda de sangre debido al envejecimiento de donantes y receptores. (3) Analiza estudios sobre la seguridad de técnicas como la inactivación en placquetas.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
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1. PHARMACOLOGICAL MANAGEMENT OFPHARMACOLOGICAL MANAGEMENT OF
PERIOPERATIVE ANAEMIA:PERIOPERATIVE ANAEMIA:
Our experience with intravenous iron inOur experience with intravenous iron in
orthopaedic surgery.orthopaedic surgery.
XVII Regional Congress Europe ISBT
XVIII National Congress SETS
Madrid, June 23 – 27, 2007
Prof. Manuel Muñoz
Transfusion Medicine
School of Medicine
Málaga - Spain
2. Acknowlegments
Dr. J.A. García Erce
Department of Haematology
University Hospital Miguel Servet, Zaragoza
Dr. J. Cuenca
Department of Orthopaedic Surgery
University Hospita Miguel Servet, Zaragoza
Dr. E. Bisbe
Department of Anaesthesiology
University Hospital Mar-Esperança, Barcelona
3. Where do we use blood?
Stanworth et al. Vox Sang 2002; 83: 352-7
Specialty (Directorate) Hospitals (n: 62) Units issued % of traced units
General Surgery 52 81 011 13·62
General & Orthopaedic Surgery 3 9228 1·55
Orthopaedic Surgery only 53 60 470 10·17
Cardiothoracic Surgery 11 48 148 8·14
Accident and Emergency (A & E) 45 33 256 5·59
A & E and Intensive Therapy 1 1105 0·19
Intensive Therapy 20 7328 1·23
Obstetrics/Gynaecology 53 31 101 5·23
Urology 34 15 093 2·54
Neurosurgery 10 5733 0·96
Vascular Surgery alone 8 5387 0·91
Colorectal Surgery 1 1473 0·25
Ear, Nose & Throat (ENT) 30 1966 0·33
Plastic/Maxillofacial/Burns 17 3220 0·54
Total in surgical specialties 304 519 51·25
4. Regan y Taylor, BMJ 2002
Shander, Semin Hematol 2004
Costs are increasingly rising
Limited resource
Reasons for reducing ABT use
5. Kleinman et al. Transfusion 2004; 44: 386-90
60%
6779 patients transfused in 1995
Reasons for reducing ABT use
6. Regan y Taylor, BMJ 2002
Shander, Semin Hematol 2004
Reasons for reducing ABT use
Costs are increasingly rising
Limited resource
Adverse effects
Clerical errors (Wrong blood)
Viral transmission
Inmunological complications
(TRALI, GVHD, TRIM)
8. 12. Patients should be informed of the known risks and
benefits of blood transfusion and/or alternative
therapies and have the right to accept or refuse the
procedure. Any valid advance directive should be
respected.
Principle of patient’s autonomy
15. Genuine clinical need should be the only basis for
transfusion therapy.
Ethical principles of beneficence and justice
Blood transfusion: Ethical balance
10. Preoperative haemoglobin level is the major independent
transfusional risk factor in elective orthopaedic surgery
• Nuttall GA et al. Transfusion 1996; 36: 144-149
• Salido JA et al. J Bone Joint Surg 2002; 84-A: 216-220
• Garcia-Erce JA et al. Rev Esp Anestesiol Reanim 2002;49:254-6
As well as in non-elective orthopaedic surgery
• García Erce JA, et al. Med Clin (Barc) 2003; 120: 161-166.
Anaemia, surgery and transfusion
12. BLOOD LOST
Capsule
Fragmentation
Displacement
Surgery
PREVIOUS CHRONIC ANAEMIA
Transfusion rate: 40-90%
HIP FRACTURE AND ANAEMIA
INFLAMMATION: “hepcidin”
The standard solution
13. Possible role for IV iron
Muscles
(250 mg)
Bone marrow
(300 mg)
Erythrocytes
(2.000 mg)
Macrophages
(500 mg)
Liver
(1000 mg)
Iron absorption
(1-2 mg/day)
Transferrin
(3 mg)
Iron loss
(1-2 mg/day)
20-30
mg/día
Iron sucrose
21. Preoperative anaemia
Bisbe E, Lamsfus JA. Alteración de los parámetros hematológicos en el preoperatorio de
cirugía ortopédica mayor: prevalencia y tratamiento. In: Muñoz M, Bisbe E, García-Erce JA,
Giralt M (eds): Actualización en Anemia y Medicina Transfusional Perioperatoria. Málaga,
SPICUM, 2006: 55-62.
22. Patients and methods: We assessed the requirements for ABT in 156 consecutive patients
undergoing surgery for primary TKR, who received iron ferrous sulphate (256 mg/day; 80
mg of Fe2+
), vitamin C (1000 mg/day) and folic acid (5 mg/day) during the 30-45 days
preceding surgery, and who were transfused if Hb <80 g/L and/or clinical signs/symptoms
of acute anaemia or hypoxemia (Group 2). A previous series of 156 TKR patients serves as a
control group (Group 1).
Oral iron and knee surgery
26. IV iron and knee surgery
Blood saving protocol
• In Group A (n=139), consecutive TKR patients received iron sucrose
intravenously (200 mg), 24 hours before surgery and 24 hours after
surgery. Patients with preoperative Hb levels <13 g/dL also received a
single dose of rHuEPO (40,000 IU, sc; Eprex) 24 hours before surgery.
• This protocol plus was applied to a second series of consecutiveTKR
patients who also received postoperative unwashed shed blood (USB) if
preoperative Hb levels <13 g/dL (Group B, n=173).
• In these two groups, transfusion was indicated when patient’s Hb <8
g/dL or when patient presented symptoms of acute anemia.
27. IV iron and knee surgery
Overall ABT rate:
4.2%
29. Orthopaedic surgery
Non-elective procedure
Hip fracture repair
Elective procedures
Preoperative period
Perioperative period
Postoperative period
32. Postop oral iron and hip/knee surgery
Randomised controlled trials in orthopaedics
Ferrous sulphate (200 mg/d) 3 weeks
Mundy et al. JBJS 2005; 87-B: 213-7
Ferrous sulphate (200 mg/d) 6 weeks
Sutton et al. JBJS 2004; 86-B: 31-3
Ferrous gluconate (325 mg/d) 10 weeks
Weatherall et al. ANZ J Surg 2004; 74: 1049-51
Oral iron did not improve haemoglobin levels !!!!
33. Conclusions
NATA Expert Panel on Intravenous Iron
ANAEMIA MANAGEMENT IN SURGERY –
CONSENSUS STATEMENT ON THE ROLE OF INTRAVENOUS IRON
Photis Beris, Manuel Muñoz, José A. García-Erce,
Dafydd Thomas, Alice Maniatis & Philippe Van der Linden.
- Grade of recommendation: .
“For patients undergoing orthopaedic surgery expected to develop severe
postoperative anaemia we currently suggest IV iron administration during
the perioperative period”. For all other surgeries no evidence-based
recommendation can be made. We strongly recommend that large prospective
randomised controlled trials are undertaken in patients undergoing surgery
expected to develop severe post operative anaemia.
34. Whenever clinically feasible, patients undergoing orthopaedic elective
surgery with a high risk of severe postoperative anaemia should have
haemoglobin level and iron status tested a minimum of 30 days
before the scheduled surgical procedure.
Unexplained anemia should always be considered as secondary to
some other process and, therefore, elective surgery should be deferred
until an appropriate diagnosis has been made
Good practice points
Patients at risk of receiving perioperative transfusions should be
identified, on the basis of patient’s RBC mass, the transfusion trigger
and the expected blood loss (e.g., using Mercuriali’s algorithm)
35. Non-anaemic patients with ferritin <100 ng/mL and scheduled for
surgical procedures with an expected blood loss >1500 mL (Hb drop 3-5
g/dL) might benefit from preoperative oral or IV iron administration, as
they may not have enough stored iron to reconstitute their perioperative Hb
loss and keep normal iron stores (ferritin ≥30 ng/mL)
Good practice points
Patients with preoperative IDA or ACD might receive preoperative
treatment with IV iron, with or without rHuEPO. In addition, IV iron
should be given to improve the response to rHuEPO and might allow for a
reduction in the total dose of rHuEPO
The administration of IV iron should be avoided in patients with pre-
treatment ferritin > 500 ng/mL. Nevertheless, IV iron should no be given
to patient with ongoing bacteremia
Thank you for your kind attention!