Anemia Management

Reports have indicated that up to 35% of patients undergoing joint arthroplasty are anemic preoperatively, with significant consequences of greater likelihood of allogeneic blood transfusions along with a higher rate of postoperative infections and hospital length of stay. Iron deficiency has been shown to be related to mortality and morbidity, and knowing the type of anaemia allows it to be treated effectively.

According to these and other authors iron deficiency anemia is more common than generally recognized, has been estimated to increase the cost of health care delivery by 50% (Spence 2007, N

With the availability of erythropoietin (EPO) and erythopoietic-stimulating agents (EPAs) came the awareness that these agents need adequate amounts of iron to generate adequate hemoglobin (Hb) levels. In this review, Auerbach and colleagues assess the paradigms of IV iron administration to correct anemia, with a special emphasis on avoiding transfusion in surgery and other disease conditions. The four commercially available iron preparations are low-molecular-weight iron dextran (LMW ID), iron saccharate, ferric gluconate, and high-molecular-weight ID.

Although patients with acute ischemic stroke (AIS), subarachnoid hemorrhage, (SAH), and traumatic brain injury (TBI) have high red blood cell transfusion (RBCT) needs, some evidence indicates that RBCTs in these patients can lead to poor clinical outcomes. In this review, Leal-Noval and colleagues discuss the effects of RBCT on cerebral function and clinical outcomes in patients with AIS, SAH, and TBI. The brain can compensate to maintain cerebral blood flow (CBF) and oxygen delivery during anemia and in normal individuals, these mechanisms are disrupted only at very low hemoglobin levels.

The presence of preoperative anemia is frequent among patients undergoing cardiac surgery and is a major determinant of the need for RBC transfusions. If it is a specific cause of adverse outcomes, it can and should be diagnosed and treated. In this retrospective, multicenter, cohort study, Karkouti and colleagues assessed the independent relationship between preoperative anemia and outcomes after cardiac surgery using data from 3500 consecutive patients operated on at seven academic hospitals in 2004.

Anemia of chronic disease (ACD) is a hypoproliferative disorder that develops as a response to systemic illness or inflammation. Traditionally, it was thought to be an adverse consequence of systemic illness. However, Zarychanski and Houston believe that ACD is an adaptive response to an underlying disease state and support this argument in this article. Anemia in these circumstances is thought to be deleterious because the decrease in RBCs causes a decrease in oxygen-carrying capabilities and anemia is connected to a poor prognosis in many clinical disorders.

The prevalence of atrial fibrillation (AF) among people older than 75 y is 12%, with a similar prevalence for anemia in people aged 75-84 y; anemia occurs in 25% of people older than 85 y. Although anemia is implicated as a prognostic marker and carries an increased mortality among patients with heart disease and HIV infection, no study has investigated specifically the association between AF, anemia, and outcomes.

Am J Cardiol. 2009 Aug 15;104(4):486-491. Epub 2009 Jun 24

Am J Nephrol. 2009;29(5):392-397. Epub 2008 Oct 31