Department of Pathology and Medicine, Stanford University School of Medicine, Pasteur Dr., Stanford, CA 94305, USA.
Br J Anaesth. 2011 Jan;106(1):13-22. doi: 10.1093/bja/aeq361.
Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient's target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcomes.
择期骨科手术患者中常存在未诊断的贫血，且与输血风险增加以及围手术期发病率和死亡率增加相关。因此，确定了针对该人群贫血的检测、评估和管理的标准化方法，以满足未满足的医疗需求。美国替代输血网络（NATA）召集了一个多学科医师小组，旨在制定择期骨科手术患者术前贫血检测、评估和管理的临床实践指南。进行了系统的文献复习和证据的严格评估，并根据推荐评估、制定与评价（GRADE）工作组提出的方法制定了建议。我们建议择期骨科手术患者如果可能，应在计划手术前 28 天确定血红蛋白（Hb）水平（1C 级）。我们建议根据世界卫生组织（WHO）标准，患者择期手术前的目标 Hb 值应在正常范围内（2C 级）。我们建议进一步进行实验室检查以评估营养缺乏、慢性肾功能不全和/或慢性炎症性疾病引起的贫血（1C 级）。我们建议治疗营养缺乏（1C 级）。我们建议对于已排除、纠正或两者兼有的营养缺乏性贫血患者，使用促红细胞生成素刺激剂（2A 级）。贫血应被视为一种严重且可治疗的疾病，而不仅仅是实验室的异常值。在择期骨科手术中实施贫血管理将改善患者结局。
