Department of Anaesthesiology, Singapore General Hospital, Singapore.
Department of Haematology, Singapore General Hospital, Singapore.
Singapore Med J. 2020 Jun;61(6):287-296. doi: 10.11622/smedj.2019037. Epub 2019 May 2.
Preoperative anaemia is common in the Asia-Pacific. Iron deficiency anaemia (IDA) is a risk factor that can be addressed under patient blood management (PBM) Pillar 1, leading to reduced morbidity and mortality. We examined PBM implementation under four different healthcare systems, identified challenges and proposed several measures: (a) Test for anaemia once patients are scheduled for surgery. (b) Inform patients about risks of preoperative anaemia and benefits of treatment. (c) Treat IDA and replenish iron stores before surgery, using intravenous iron when oral treatment is ineffective, not tolerated or when rapid iron replenishment is needed; transfusion should not be the default management. (d) Harness support from multiple medical disciplines and relevant bodies to promote PBM implementation. (e) Demonstrate better outcomes and cost savings from reduced mortality and morbidity. Although PBM implementation may seem complex and daunting, it is feasible to start small. Implementing PBM Pillar 1, particularly in preoperative patients, is a sensible first step regardless of the healthcare setting.
围手术期贫血在亚太地区很常见。缺铁性贫血 (IDA) 是患者血液管理 (PBM) 支柱 1 下可以解决的风险因素，可降低发病率和死亡率。我们研究了在四种不同医疗体系下的 PBM 实施情况，确定了挑战并提出了一些措施：(a) 一旦患者计划手术，就进行贫血检测。(b) 告知患者术前贫血的风险和治疗的益处。(c) 在手术前治疗 IDA 和补充铁储存，当口服治疗无效、不耐受或需要快速补铁时使用静脉铁；输血不应作为默认治疗。(d) 利用多个医学学科和相关机构的支持来促进 PBM 的实施。(e) 通过降低死亡率和发病率来证明更好的结果和节省成本。尽管 PBM 的实施看起来复杂且令人生畏，但从小处着手是可行的。无论医疗环境如何，实施 PBM 支柱 1，特别是针对术前患者，都是明智的第一步。
