Skip to main content

Advertisement

SpringerLink
Log in

Preoperative Anemia Management: What’s New in 2020?

  • Blood Management (KA Tanaka, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this article is to review the relevant evidence regarding the clinical impact of preoperative anemia, current methods of identifying anemia in the surgical population, and the current and upcoming evidence for the treatment modalities targeting preoperative anemia.

Recent Findings

Preoperative anemia continues to be identified as a contributor to poor outcomes in the surgical population. Identifying anemia typically starts with hemoglobin and mean corpuscular volume. Recent laboratories have also started using iron studies with serum ferritin and transferrin saturation. Oral and IV iron have demonstrated efficacy in treating preoperative anemia in terms of increasing hemoglobin preoperatively and reducing allogeneic blood transfusions. However, few studies have demonstrated an impact on patient outcomes, morbidity, and mortality. Additionally, several meta-analyses have demonstrated the benefit of adding erythropoietin-stimulating agents to improve anemia.

Summary

Preoperative anemia is very common and is thought to be a contributor to poor outcomes. IV iron is currently recommended by several guidelines as the primary treatment modality for preoperative anemia. Two ongoing studies hope to provide clarity on the effect of IV iron on patient outcomes including morbidity and mortality in cardiac and non-cardiac surgical populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Goodnough LT, Nissenson AR. Anemia and its clinical consequences in patients with chronic diseases. Am J Med. 2004;116(Suppl 7A):1s–2s.

    Article  PubMed  Google Scholar 

  2. • Le CH. The prevalence of anemia and moderate-severe anemia in the US population (NHANES 2003-2012). PLoS One. 2016;11(11):e0166635. Identification of the prevalence of anemia in the general US population.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Migone De Amicis M, Poggiali E, Motta I, Minonzio F, Fabio G, Hu C, et al. Anemia in elderly hospitalized patients: prevalence and clinical impact. Intern Emerg Med. 2015;10(5):581–6.

    Article  PubMed  Google Scholar 

  4. Kalaivani K. Prevalence & consequences of anaemia in pregnancy. Indian J Med Res. 2009;130(5):627–33.

    CAS  PubMed  Google Scholar 

  5. Marahatta R. Study of anaemia in pregnancy and its outcome in Nepal Medical College Teaching Hospital, Kathmandu, Nepal. Nepal Medical College journal : NMCJ. 2007;9(4):270–4.

    CAS  PubMed  Google Scholar 

  6. Sim YE, Wee HE, Ang AL, Ranjakunalan N, Ong BC, Abdullah HR. Prevalence of preoperative anemia, abnormal mean corpuscular volume and red cell distribution width among surgical patients in Singapore, and their influence on one year mortality. PLoS One. 2017;12(8):e0182543.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. • Padmanabhan H, Siau K, Curtis J, Ng A, Menon S, Luckraz H, et al. Preoperative anemia and outcomes in cardiovascular surgery: systematic review and meta-analysis. Ann Thorac Surg. 2019;108(6):1840–8. Meta-analysis identifying anemia as a poor outcome in patients undergoing cardiac surgery.

    Article  PubMed  Google Scholar 

  8. Klein AA, Collier TJ, Brar MS, Evans C, Hallward G, Fletcher SN, et al. The incidence and importance of anaemia in patients undergoing cardiac surgery in the UK - the first Association of Cardiothoracic Anaesthetists national audit. Anaesthesia. 2016;71(6):627–35.

    Article  CAS  PubMed  Google Scholar 

  9. Remacha AF, Wright I, Fernandez-Jimenez MC, Toxqui L, Blanco-Rojo R, Moreno G, et al. Vitamin B12 and folate levels increase during treatment of iron deficiency anaemia in young adult woman. Int J Lab Hematol. 2015;37(5):641–8.

    Article  CAS  PubMed  Google Scholar 

  10. •• Mueller MM, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R, et al. Patient blood management: recommendations from the 2018 Frankfurt consensus conference. Jama. 2019;321(10):983–97. Recommendations from an internation consensus conference on patient blood management. There was general agreement that preoperative anemia should be formally evaluated and treated in surgical patients.

    Article  PubMed  Google Scholar 

  11. Deepak B, Balaji A, Pramod A, Sujit K, Savani F, Bapu K, et al. The prevalence and impact of preoperative anemia in patients undergoing cardiac surgery for rheumatic heart disease. J Cardiothorac Vasc Anesth. 2016;30(4):896–900.

    Article  PubMed  Google Scholar 

  12. LaPar DJ, Hawkins RB, McMurry TL, Isbell JM, Rich JB, Speir AM, et al. Preoperative anemia versus blood transfusion: which is the culprit for worse outcomes in cardiac surgery? J Thorac Cardiovasc Surg. 2018;156(1):66–74.e2.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Miceli A, Romeo F, Glauber M, de Siena PM, Caputo M, Angelini GD. Preoperative anemia increases mortality and postoperative morbidity after cardiac surgery. J Cardiothorac Surg. 2014;9:137.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Oprea AD, Del Rio JM, Cooter M, Green CL, Karhausen JA, Nailer P, et al. Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study. Can J Anaesth. 2018;65(1):46–59.

    Article  PubMed  Google Scholar 

  15. Meybohm P, Westphal S, Ravn HB, Ranucci M, Agarwal S, Choorapoikayil S, et al. Perioperative anemia management as part of PBM in cardiac surgery - a narrative updated review. J Cardiothorac Vasc Anesth. 2019.

  16. • Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 2015;102(11):1314–24. Large meta-analysis showing that preoperative anemia is associated with increased mortality.

    Article  CAS  PubMed  Google Scholar 

  17. • Karkouti K, Wijeysundera DN, Beattie WS. Risk associated with preoperative anemia in cardiac surgery: a multicenter cohort study. Circulation. 2008;117(4):478–84 Major study identifying preoperative anemia.

    Article  PubMed  Google Scholar 

  18. Shavit L, Hitti S, Silberman S, Tauber R, Merin O, Lifschitz M, et al. Preoperative hemoglobin and outcomes in patients with CKD undergoing cardiac surgery. Clin J Am Soc Nephrol. 2014;9(9):1536–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Beattie WS, Karkouti K, Wijeysundera DN, Tait G. Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology. 2009;110(3):574–81.

    Article  PubMed  Google Scholar 

  20. Smilowitz NR, Oberweis BS, Nukala S, Rosenberg A, Zhao S, Xu J, et al. Association between anemia, bleeding, and transfusion with long-term mortality following noncardiac surgery. Am J Med. 2016;129(3):315–23.e2.

    Article  PubMed  Google Scholar 

  21. Elsamadicy AA, Adogwa O, Vuong VD, Mehta AI, Vasquez RA, Cheng J, et al. Association of intraoperative blood transfusions on postoperative complications, 30-day readmission rates, and 1-year patient-reported outcomes. Spine. 2017;42(8):610–5.

    Article  PubMed  Google Scholar 

  22. Carson JL, Triulzi DJ, Ness PM. Indications for and adverse effects of red-cell transfusion. N Engl J Med. 2017;377(13):1261–72.

    Article  PubMed  Google Scholar 

  23. Isbister JP, Shander A, Spahn DR, Erhard J, Farmer SL, Hofmann A. Adverse blood transfusion outcomes: establishing causation. Transfus Med Rev. 2011;25(2):89–101.

    Article  PubMed  Google Scholar 

  24. Shander A, Knight K, Thurer R, Adamson J, Spence R. Prevalence and outcomes of anemia in surgery: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):58s–69s.

    Article  PubMed  Google Scholar 

  25. Goodnough LT, Maniatis A, Earnshaw P, Benoni G, Beris P, Bisbe E, et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth. 2011;106(1):13–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Gupta PK, Sundaram A, Mactaggart JN, Johanning JM, Gupta H, Fang X, et al. Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations. Ann Surg. 2013;258(6):1096–102.

    Article  PubMed  Google Scholar 

  27. Goodnough LT, Schrier SL. Evaluation and management of anemia in the elderly. Am J Hematol. 2014;89(1):88–96.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Munoz M, Gomez-Ramirez S, Campos A, Ruiz J, Liumbruno GM. Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus. 2015;13(3):370–9.

    PubMed  PubMed Central  Google Scholar 

  29. Guinn NR, Guercio JR, Hopkins TJ, Grimsley A, Kurian DJ, Jimenez MI, et al. How do we develop and implement a preoperative anemia clinic designed to improve perioperative outcomes and reduce cost? Transfusion. 2016;56(2):297–303.

    Article  PubMed  Google Scholar 

  30. Pujol-Nicolas A, Morrison R, Casson C, Khan S, Marriott A, Tiplady C, et al. Preoperative screening and intervention for mild anemia with low iron stores in elective hip and knee arthroplasty. Transfusion. 2017;57(12):3049–57.

    Article  CAS  PubMed  Google Scholar 

  31. Burton BN, A'Court AM, Brovman EY, Scott MJ, Urman RD, Gabriel RA. Optimizing preoperative anemia to improve patient outcomes. Anesthesiol Clin. 2018;36(4):701–13.

    Article  PubMed  Google Scholar 

  32. Jin L, Kapadia TY, Von Gehr A, Rosas E, Bird JB, Ramaswamy D, et al. Feasibility of a preoperative anemia protocol in a large integrated health care system. Perm J. 2019;23.

  33. Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006;107(5):1747–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician. 2013;87(2):98–104.

    PubMed  Google Scholar 

  35. Goodnough LT, Shander A, Spivak JL, Waters JH, Friedman AJ, Carson JL, et al. Detection, evaluation, and management of anemia in the elective surgical patient. Anesth Analg. 2005;101(6):1858–61.

    Article  PubMed  Google Scholar 

  36. Shah N, Andrews J, Goodnough LT. Transfusions for anemia in adult and pediatric patients with malignancies. Blood Rev. 2015;29(5):291–9.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Goodnough L, Comin-Colet J, Leal-Noval S, Ozawa S, Takere J, Henry D, et al. Management of anemia in patients with congestive heart failure. Am J Hematol. 2017;92(1):88–93.

    Article  Google Scholar 

  38. Brugnara C, Zurakowski D, DiCanzio J, Boyd T, Platt O. Reticulocyte hemoglobin content to diagnose iron deficiency in children. JAMA. 1999;281(23):2225–30.

    Article  CAS  PubMed  Google Scholar 

  39. Mateos ME, De-la-Cruz J, Lopez-Laso E, Valdes MD, Nogales A. Reticulocyte hemoglobin content for the diagnosis of iron deficiency. J Pediatr Hematol Oncol. 2008;30(7):539–42.

    Article  CAS  PubMed  Google Scholar 

  40. Kuehn D, Roberts SS, Olsen CH, Harvey DN, Charnock KM, Brewer BD, et al. Reticulocyte hemoglobin content testing for iron deficiency in healthy toddlers. Mil Med. 2012;177(1):91–5.

    Article  PubMed  Google Scholar 

  41. Thomas C, Kirschbaum A, Boehm D, Thomas L. The diagnostic plot: a concept for identifying different states of iron deficiency and monitoring the response to epoetin therapy. Med Oncol. 2006;23(1):23–36.

    Article  CAS  PubMed  Google Scholar 

  42. Enko D, Wallner F, von- Goedecke A, Hirschmugl C, Auersperg V, Halwachs-Baumann G. The impact of an algorithm-guided management of preoperative anemia in perioperative hemoglobin level and transfusion of major orthopedic surgery patients. Anemia. 2013;2013:641876.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58(3):277–80.

    Article  CAS  PubMed  Google Scholar 

  44. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on preanesthesia evaluation. Anesthesiology. 2012;116(3):522–38.

  45. Munoz M, Acheson AG, Auerbach M, Besser M, Habler O, Kehlet H, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72(2):233–47.

    Article  CAS  PubMed  Google Scholar 

  46. Kotze A, Harris A, Baker C, Iqbal T, Lavies N, Richards T, et al. British committee for standards in haematology guidelines on the identification and management of pre-operative anaemia. Br J Haematol. 2015;171(3):322–31.

    Article  PubMed  Google Scholar 

  47. Fischer DP, Zacharowski KD, Muller MM, Geisen C, Seifried E, Muller H, et al. Patient blood management implementation strategies and their effect on physicians’ risk perception, clinical knowledge and perioperative practice - the frankfurt experience. Transfus Med Hemother. 2015;42(2):91–7.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Aronson S, Grocott MPW, Mythen MMG. Preoperative patient preparation, programs, and education in the United States: state of the art, state of the science, and state of affairs. Adv Anesth. 2019;37:127–43.

    Article  PubMed  Google Scholar 

  49. Baird-Gunning J, Bromley J. Correcting iron deficiency. Aust Prescr. 2016;39(6):193–9.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Stoffel NU, Zeder C, Brittenham GM, Moretti D, Zimmermann MB. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica. 2019.

  51. Fernandez-Gaxiola AC, De-Regil LM. Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women. Cochrane Database Syst Rev. 2019;1:Cd009218.

    PubMed  Google Scholar 

  52. Moretti D, Goede JS, Zeder C, Jiskra M, Chatzinakou V, Tjalsma H, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood. 2015;126(17):1981–9.

    Article  CAS  PubMed  Google Scholar 

  53. Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832–43.

    Article  PubMed  Google Scholar 

  54. Lidder PG, Sanders G, Whitehead E, Douie WJ, Mellor N, Lewis SJ, et al. Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery - a prospective, randomised, controlled trial. Ann R Coll Surg Engl. 2007;89(4):418–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Okuyama M, Ikeda K, Shibata T, Tsukahara Y, Kitada M, Shimano T. Preoperative iron supplementation and intraoperative transfusion during colorectal cancer surgery. Surg Today. 2005;35(1):36–40.

    Article  CAS  PubMed  Google Scholar 

  56. Quinn M, Drummond RJ, Ross F, Murray J, Murphy J, Macdonald A. Short course pre-operative ferrous sulphate supplementation--is it worthwhile in patients with colorectal cancer? Ann R Coll Surg Engl. 2010;92(7):569–72.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Cuenca J, Garcia-Erce JA, Martinez F, Cardona R, Perez-Serrano L, Munoz M. Preoperative haematinics and transfusion protocol reduce the need for transfusion after total knee replacement. Int J Surg. 2007;5(2):89–94.

    Article  PubMed  Google Scholar 

  58. Kotze A, Carter LA, Scally AJ. Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Br J Anaesth. 2012;108(6):943–52.

    Article  CAS  PubMed  Google Scholar 

  59. Scardino M, Di Matteo B, Martorelli F, Tanzi D, Kon E, D'Amato T. Improved patient blood management and cost saving in hip replacement surgery through the implementation of pre-operative Sucrosomial® iron supplementation: a quality improvement assessment study. Int Orthop. 2019;43(1):39–46.

    Article  PubMed  Google Scholar 

  60. Gomez-Ramirez S, Bisbe E, Shander A, Spahn DR, Munoz M. Management of perioperative iron deficiency anemia. Acta Haematol. 2019;142(1):21–9.

    Article  CAS  PubMed  Google Scholar 

  61. •• Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology. 2015;122(2):241–75. ASA guidelines on management of anemia in the surgical population.

  62. Goodnough LT, Skikne B, Brugnara C. Erythropoietin, iron, and erythropoiesis. Blood. 2000;96(3):823–33.

    Article  CAS  PubMed  Google Scholar 

  63. • Banerjee S, McCormack S. CADTH rapid response reports. Intravenous iron preparations for patients undergoing elective surgery: a review of clinical effectiveness, cost-effectiveness, and guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health Copyright (c) 2019. Can Agency Drugs Technol Health. 2019; Canadian guidelines evaluating evidence for IV iron preparations in treating preoperative anemia.

  64. Serrano-Trenas JA, Ugalde PF, Cabello LM, Chofles LC, Lazaro PS, Benitez PC. Role of perioperative intravenous iron therapy in elderly hip fracture patients: a single-center randomized controlled trial. Transfusion. 2011;51(1):97–104.

    Article  CAS  PubMed  Google Scholar 

  65. Froessler B, Palm P, Weber I, Hodyl NA, Singh R, Murphy EM. The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Ann Surg. 2016;264(1):41–6.

    Article  PubMed  Google Scholar 

  66. Bernabeu-Wittel M, Romero M, Ollero-Baturone M, Aparicio R, Murcia-Zaragoza J, Rincon-Gomez M, et al. Ferric carboxymaltose with or without erythropoietin in anemic patients with hip fracture: a randomized clinical trial. Transfusion. 2016;56(9):2199–211.

    Article  CAS  PubMed  Google Scholar 

  67. Keeler BD, Dickson EA, Simpson JA, Ng O, Padmanabhan H, Brookes MJ, et al. The impact of pre-operative intravenous iron on quality of life after colorectal cancer surgery: outcomes from the intravenous iron in colorectal cancer-associated anaemia (IVICA) trial. Anaesthesia. 2019;74(6):714–25.

    Article  CAS  PubMed  Google Scholar 

  68. Edwards TJ, Noble EJ, Durran A, Mellor N, Hosie KB. Randomized clinical trial of preoperative intravenous iron sucrose to reduce blood transfusion in anaemic patients after colorectal cancer surgery. Br J Surg. 2009;96(10):1122–8.

    Article  CAS  PubMed  Google Scholar 

  69. Cuenca J, Garcia-Erce JA, Martinez AA, Solano VM, Molina J, Munoz M. Role of parenteral iron in the management of anaemia in the elderly patient undergoing displaced subcapital hip fracture repair: preliminary data. Arch Orthop Trauma Surg. 2005;125(5):342–7.

    Article  PubMed  Google Scholar 

  70. Cuenca J, Garcia-Erce JA, Munoz M, Izuel M, Martinez AA, Herrera A. Patients with pertrochanteric hip fracture may benefit from preoperative intravenous iron therapy: a pilot study. Transfusion. 2004;44(10):1447–52.

    Article  CAS  PubMed  Google Scholar 

  71. Gonzalez-Porras JR, Colado E, Conde MP, Lopez T, Nieto MJ, Corral M. An individualized pre-operative blood saving protocol can increase pre-operative haemoglobin levels and reduce the need for transfusion in elective total hip or knee arthroplasty. Transfus Med. 2009;19(1):35–42.

    Article  CAS  PubMed  Google Scholar 

  72. Blanco Rubio N, Llorens Eizaguerri M, Seral Garcia B, Burillo Fuertes P, Ranera Garcia M, Albareda Albareda J. Preoperative intravenous iron as a strategy for blood saving in surgery for hip fracture. Med Clin (Barc). 2013;141(9):371–5.

    Article  Google Scholar 

  73. Theusinger OM, Leyvraz PF, Schanz U, Seifert B, Spahn DR. Treatment of iron deficiency anemia in orthopedic surgery with intravenous iron: efficacy and limits: a prospective study. Anesthesiology. 2007;107(6):923–7.

    Article  CAS  PubMed  Google Scholar 

  74. Heschl M, Gombotz H, Haslinger-Eisterer B, Hofmann A, Bohler N, Meier J. The efficacy of pre-operative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: an observational study. Eur J Anaesthesiol. 2018;35(4):289–97.

    Article  CAS  PubMed  Google Scholar 

  75. Calleja JL, Delgado S, del Val A, Hervas A, Larraona JL, Teran A, et al. Ferric carboxymaltose reduces transfusions and hospital stay in patients with colon cancer and anemia. Int J Color Dis. 2016;31(3):543–51.

    Article  Google Scholar 

  76. Laso-Morales M, Jerico C, Gomez-Ramirez S, Castellvi J, Viso L, Roig-Martinez I, et al. Preoperative management of colorectal cancer-induced iron deficiency anemia in clinical practice: data from a large observational cohort. Transfusion. 2017;57(12):3040–8.

    Article  CAS  PubMed  Google Scholar 

  77. Wilson MJ, Dekker JW, Bruns E, Borstlap W, Jeekel J, Zwaginga JJ, et al. Short-term effect of preoperative intravenous iron therapy in colorectal cancer patients with anemia: results of a cohort study. Transfusion. 2018;58(3):795–803.

    Article  CAS  PubMed  Google Scholar 

  78. Yoo YC, Shim JK, Kim JC, Jo YY, Lee JH, Kwak YL. Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery. Anesthesiology. 2011;115(5):929–37.

    Article  CAS  PubMed  Google Scholar 

  79. Munoz M, Gomez-Ramirez S, Cuenca J, Garcia-Erce JA, Iglesias-Aparicio D, Haman-Alcober S, et al. Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients. Transfusion. 2014;54(2):289–99.

    CAS  PubMed  Google Scholar 

  80. • Ng O, Keeler BD, Mishra A, Simpson JA, Neal K, Al-Hassi HO, et al. Iron therapy for preoperative anaemia. Cochrane Database Syst Rev. 2019;12:Cd011588. Updated Cochrane systematic review analyzing evidence for iron in preoperative anemia.

    PubMed  Google Scholar 

  81. Richards T, Clevenger B, Keidan J, Collier T, Klein AA, Anker SD, et al. PREVENTT: preoperative intravenous iron to treat anaemia in major surgery: study protocol for a randomised controlled trial. Trials. 2015;16:254.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  82. Girelli D, Ugolini S, Busti F, Marchi G, Castagna A. Modern iron replacement therapy: clinical and pathophysiological insights. Int J Hematol. 2018;107(1):16–30.

    Article  CAS  PubMed  Google Scholar 

  83. Ishida JH, Johansen KL. Iron and infection in hemodialysis patients. Semin Dial. 2014;27(1):26–36.

    Article  PubMed  Google Scholar 

  84. Avni T, Bieber A, Grossman A, Green H, Leibovici L, Gafter-Gvili A. The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clin Proc. 2015;90(1):12–23.

    Article  PubMed  CAS  Google Scholar 

  85. Shin HW, Park JJ, Kim HJ, You HS, Choi SU, Lee MJ. Efficacy of perioperative intravenous iron therapy for transfusion in orthopedic surgery: a systematic review and meta-analysis. PLoS One. 2019;14(5):e0215427.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Gomez-Ramirez S, Shander A, Spahn DR, Auerbach M, Liumbruno GM, Vaglio S, et al. Prevention and management of acute reactions to intravenous iron in surgical patients. Blood Transfus. 2019;17(2):137–45.

    PubMed  Google Scholar 

  87. Li Y, Yin P, Lv H, Meng Y, Zhang L, Tang P. A meta-analysis and systematic review evaluating the use of erythropoietin in total hip and knee arthroplasty. Ther Clin Risk Manag. 2018;14:1191–204.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Cho BC, Serini J, Zorrilla-Vaca A, Scott MJ, Gehrie EA, Frank SM, et al. Impact of preoperative erythropoietin on allogeneic blood transfusions in surgical patients: results from a systematic review and meta-analysis. Anesth Analg. 2019;128(5):981–92.

    Article  CAS  PubMed  Google Scholar 

  89. Kei T, Mistry N, Curley G, Pavenski K, Shehata N, Tanzini RM, et al. Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis. Can J Anaesth. 2019;66(6):716–31.

    Article  PubMed  Google Scholar 

  90. Mazzeffi M, Chow JH, Tanaka K. Preoperative erythropoietin in cardiac surgery: evolving standard of care or aggregation of marginal gain? Anesth Analg. 2019;129(3):e110–e1.

    Article  PubMed  Google Scholar 

  91. Spahn DR, Schoenrath F, Spahn GH, Seifert B, Stein P, Theusinger OM, et al. Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial. Lancet. 2019;393(10187):2201–12.

    Article  PubMed  Google Scholar 

  92. Theusinger OM, Kind SL, Seifert B, Borgeat L, Gerber C, Spahn DR. Patient blood management in orthopaedic surgery: a four-year follow-up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich, Switzerland. Blood Transfus. 2014;12(2):195–203.

    PubMed  PubMed Central  Google Scholar 

  93. Klein AA, Bailey CR, Charlton A, Lawson C, Nimmo AF, Payne S, et al. Association of Anaesthetists: anaesthesia and peri-operative care for Jehovah’s Witnesses and patients who refuse blood. Anaesthesia. 2019;74(1):74–82.

    Article  CAS  PubMed  Google Scholar 

  94. Althoff FC, Neb H, Herrmann E, Trentino KM, Vernich L, Fullenbach C, et al. Multimodal patient blood management program based on a three-pillar strategy: a systematic review and meta-analysis. Ann Surg. 2019;269(5):794–804.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, University of Rochester Medical Center, Rochester, NY, USA

    Daniel A. Rubinger & Marjorie Gloff

  2. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box-608, Rochester, NY, 14642, USA

    Christine Cahill, Andy Ngo & Majed A. Refaai

Authors
  1. Daniel A. Rubinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine Cahill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andy Ngo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marjorie Gloff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Majed A. Refaai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Majed A. Refaai.

Ethics declarations

Conflict of Interest

MAR has received consulting fees and/or research funding from CSL Behring, Portola, Boehringer Ingelheim, Octapharma, Bayer, Instrumentation Laboratory, and iLine microsystems and has received speaking fees from CSL Behring.

None of the other authors have conflicts of interest to declare.

Authorship Statement

The guarantor of the article is Majed A. Refaai. DAR, CC, AN, MG, and MAR were all involved in the conception of the idea for the review, development of the literature search strategy, interpretation of the literature, and critical revision of the manuscript. All authors read and approved the final version of the manuscript.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Blood Management

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rubinger, D.A., Cahill, C., Ngo, A. et al. Preoperative Anemia Management: What’s New in 2020?. Curr Anesthesiol Rep 10, 166–175 (2020). https://doi.org/10.1007/s40140-020-00385-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40140-020-00385-7

Keywords

Search

Navigation