Department of Anaesthesia, Liverpool Heart and Chest Hospital, UK.
Liverpool Heart and Chest Hospital, UK.
Anaesthesia. 2021 May;76(5):629-638. doi: 10.1111/anae.15271. Epub 2020 Nov 5.
Pre-operative anaemia is associated with higher rates of transfusion and worse outcomes, including prolonged hospital stay, morbidity and mortality. Iron deficiency is associated with significantly lower haemoglobin levels throughout the peri-operative period and more frequent blood transfusion. Correction of iron stores before surgery forms part of the first pillar of patient blood management. We established a pre-operative anaemia clinic to aid identification and treatment of patients with iron deficiency anaemia scheduled for elective cardiac surgery. We present a retrospective observational review of our experience from January 2017 to December 2019. One-hundred and ninety patients received treatment with intravenous iron, a median of 21 days before cardiac surgery. Of these, 179 had a formal laboratory haemoglobin level measured before surgery, demonstrating a median rise in haemoglobin of 8.0 g.l . Patients treated with i.v. iron demonstrated a significantly higher incidence of transfusion (60%) compared with the non-anaemic cohort (22%) during the same time period, p < 0.001. Significantly higher rates of new requirement for renal replacement therapy (6.7% vs. 0.6%, p < 0.001) and of stroke (3.7% vs. 1.2%, p = 0.010) were also seen in this group compared with those without anaemia, although there was no significant difference in in-hospital mortality (1.6% vs. 0.8%, p = 0.230). In patients where the presenting haemoglobin was less than 130 g.l , but there was no intervention or treatment, there was no difference in rates of transfusion or of complications compared with the anaemic group treated with iron. In patients with proven iron deficiency anaemia, supplementation with intravenous iron showed only a modest effect on haemoglobin and this group still had a significantly higher transfusion requirement than the non-anaemic cohort. Supplementation with intravenous iron did not improve outcomes compared with patients with anaemia who did not receive intravenous iron and did not reduce peri-operative risk to non-anaemic levels. Questions remain regarding identification of patients who will receive most benefit, the use of concomitant treatment with other agents, and the optimum time frames for treatment in order to produce benefit in the real-world setting.
术前贫血与更高的输血率和更差的结局相关，包括住院时间延长、发病率和死亡率增加。缺铁与围手术期血红蛋白水平显著降低以及更频繁的输血相关。手术前纠正铁储存是患者血液管理的第一大支柱的一部分。我们建立了术前贫血诊所，以帮助识别和治疗计划接受择期心脏手术的缺铁性贫血患者。我们回顾性观察了 2017 年 1 月至 2019 年 12 月的经验。190 例患者接受了静脉铁治疗，中位数在心脏手术前 21 天开始治疗。其中，179 例在术前有正式的实验室血红蛋白水平测量，血红蛋白中位数升高 8.0g/L。与非贫血组（22%）相比，接受静脉铁治疗的患者在同一时期输血的发生率显著更高（60%），p<0.001。与无贫血患者相比，该组的新需要肾脏替代治疗的发生率（6.7%比 0.6%，p<0.001）和中风发生率（3.7%比 1.2%，p=0.010）也显著更高，尽管住院死亡率无显著差异（1.6%比 0.8%，p=0.230）。在血红蛋白值低于 130g/L 的患者中，如果没有干预或治疗，输血率或并发症率与接受铁治疗的贫血组相比没有差异。在有明确缺铁性贫血的患者中，静脉铁补充对血红蛋白只有适度影响，而且这组患者的输血需求仍明显高于非贫血组。与未接受静脉铁治疗的贫血患者相比，静脉铁补充并不能改善结局，也不能将围手术期风险降低到非贫血水平。关于确定哪些患者将受益最大、是否同时使用其他药物治疗以及为了在现实环境中产生获益而最佳治疗时间框架等问题仍存在疑问。
