From the Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Committee on Patient Blood Management, American Society of Anesthesiologists, Schaumburg, Illinois.
Anesth Analg. 2020 May;130(5):1364-1380. doi: 10.1213/ANE.0000000000004727.
Anemia is common in the perioperative period and is associated with poor patient outcomes. Remarkably, anemia is frequently ignored until hemoglobin levels drop low enough to warrant a red blood cell transfusion. This simplified transfusion-based approach has unfortunately shifted clinical focus away from strategies to adequately prevent, diagnose, and treat anemia through direct management of the underlying cause(s). While recommendations have been published for the treatment of anemia before elective surgery, information regarding the design and implementation of evidence-based anemia management strategies is sparse. Moreover, anemia is not solely a concern of the preoperative encounter. Rather, anemia must be actively addressed throughout the perioperative spectrum of patient care. This article provides practical information regarding the implementation of anemia management strategies in surgical patients throughout the perioperative period. This includes evidence-based recommendations for the prevention, diagnosis, and treatment of anemia, including the utility of iron supplementation and erythropoiesis-stimulating agents (ESAs).
贫血在围手术期很常见，与患者预后不良有关。值得注意的是，贫血常常被忽视，直到血红蛋白水平下降到足以需要输血的程度。这种简化的输血方法不幸地将临床重点从通过直接治疗根本原因来充分预防、诊断和治疗贫血的策略上转移开。虽然已经发布了择期手术前贫血治疗的建议，但关于设计和实施基于证据的贫血管理策略的信息却很少。此外，贫血不仅仅是术前遇到的问题。相反，必须在围手术期患者护理的整个过程中积极处理贫血。本文提供了关于在围手术期外科患者中实施贫血管理策略的实用信息。这包括预防、诊断和治疗贫血的循证建议，包括铁补充剂和促红细胞生成素刺激剂（ESA）的应用。
