Muñoz M, Breymann C, García-Erce J A, Gómez-Ramírez S, Comin J, Bisbe E
Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain.
Feto Maternal Haematology Research Group, University Hospital Zurich, Zurich, Switzerland.
Vox Sang. 2008 Apr;94(3):172-183. doi: 10.1111/j.1423-0410.2007.01014.x. Epub 2007 Dec 7.
Anaemia is a common condition among patients admitted to hospital medicosurgical departments, as well as in critically ill patients. Anaemia is more frequently due to absolute iron deficiency (e.g. chronic blood loss) or functional iron deficiency (e.g. chronic inflammatory states), with other causes being less frequent. In addition, preoperative anaemia is one of the major predictive factors for perioperative blood transfusion. In surgical patients, postoperative anaemia is mainly caused by perioperative blood loss, and it might be aggravated by inflammation-induced inhibition of erythropoietin and functional iron deficiency (a condition that cannot be corrected by the administration of oral iron). All these mechanisms may be involved in the anaemia of the critically ill. Intravenous iron administration seems to be safe, as very few severe side-effects were observed, and may result in hastened recovery from anaemia and lower transfusion requirements. However, it is noteworthy that many of the recommendations given for intravenous iron treatment are not supported by a high level of evidence and this must be borne in mind when making decisions regarding its application to a particular patient. Nonetheless, this also indicates the need for further large, randomized controlled trials on the safety and efficacy of intravenous iron for the treatment of anaemia in different clinical settings.
贫血是内科手术科室住院患者以及重症患者中的常见病症。贫血更常见的原因是绝对铁缺乏（如慢性失血）或功能性铁缺乏（如慢性炎症状态），其他原因则较少见。此外，术前贫血是围手术期输血的主要预测因素之一。在外科手术患者中，术后贫血主要由围手术期失血引起，并且可能因炎症诱导的促红细胞生成素抑制和功能性铁缺乏（一种口服铁剂无法纠正的情况）而加重。所有这些机制可能都与重症患者的贫血有关。静脉注射铁剂似乎是安全的，因为观察到的严重副作用很少，并且可能会加快贫血的恢复并降低输血需求。然而，值得注意的是，许多关于静脉注射铁剂治疗的建议并未得到高水平证据的支持，在决定将其应用于特定患者时必须牢记这一点。尽管如此，这也表明需要针对静脉注射铁剂在不同临床环境中治疗贫血的安全性和有效性进行进一步的大型随机对照试验。
