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Title: Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain
Author: Bisbe Vives, Elvira
Basora Macaya, Misericordia
Colomina Soler, M. J. (María José)
Keywords: Cirurgia ortopèdica
Dèficit de ferro
Transfusió de sang
Conservació de la sang
Orthopedic surgery
Iron deficiency diseases
Blood transfusion
Blood preservation
Issue Date: 26-Jan-2017
Publisher: Edizioni SIMTI
Abstract: In patients undergoing major orthopaedic surgery, pre-operative anaemia, peri-operative bleeding and a liberal transfusion policy are the main risk factors for requiring red blood cell transfusion (RBCT). The clinical and economic disadvantages of RBCT have led to the development and implementation of multidisciplinary, multimodal, individualised strategies, collectively termed patient blood management, which aim to reduce RBCT and improve patients' clinical outcome and safety. Within a patient blood management programme, low pre-operative haemoglobin is one of the few modifiable risk factors for RBCT. However, a survey among Anaesthesia Departments in Spain revealed that, although pre-operative assessment was performed in the vast majority of hospitals, optimisation of haemoglobin concentration was attempted in <40% of patients who may have benefitted from it, despite there being enough time prior to surgery. This indicates that haemoglobin optimisation takes planning and forethought to be implemented in an effective manner. This review, based on available clinical evidence and our experience, is intended to provide clinicians with a practical tool to optimise pre-operative haemoglobin levels, in order to minimise the risk of patients requiring RBCT. To this purpose, after reviewing the diagnostic value and limitations of available laboratory parameters, we developed an algorithm for the detection, classification and treatment of pre-operative anaemia, with a patient-tailored approach that facilitates decision-making in the pre-operative assessment. We also reviewed the efficacy of the different pharmacological options for pre-operative and post-operative management of anaemia. We consider that such an institutional pathway for anaemia management could be a viable, cost-effective strategy that is beneficial to both patients and healthcare systems.
Note: Reproducció del document publicat a:
It is part of: Blood Transfusion, 2017, vol. 15, p. 296-306
Related resource:
ISSN: 1723-2007
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)

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