Tuesday, December 13, 2016

Post-operative Anemia: Modern Approach

Up to 90% of patients undergoing major surgery may develop post-operative anemia. The term anemia refers to low hemoglobin level. The level of hemoglobin (Hb) varies across different races and age but as per the World Health Organization (WHO), Hb value below 13.0 g/dl in adult males and below 12.0 g/dl in adult females (who are not pregnant) should be considered a cut-off level for a diagnosis of anemia.

The cause of post-operative anemia is intra-operative blood loss. Patients with normal pre-operative Hb levels have been found to be anemic during post-operative follow ups. It has been observed that patients undergo down regulation of intestinal absorption of iron along with impaired mobilization of iron from body stores. Oral iron therapy is not generally recommended to increase Hb levels in post-operative patients.

Intra-operative and post-operative allogenic blood transfusions are generally done to overcome the anemia. The modern approach to overcome the post-operative anemia recommends pre-operative iron supplementation. Intravenous or infusible iron solutions like iron-isomaltoside 1000 solution has reduced the need for intra-operative allogenic blood transfusions.

The patients undergoing major surgeries should undergo following investigations:
·         Hemogram (including reticulocyte count)
·         Serum iron, ferritin and transferrin saturation
·         Carbohydrate Reactive Protein (C.R.P.) to rule out and active inflammation
·         Serum B-12 and Folic Acid levels should also be worked out in elderly patients

Available literature supports intravenous iron formulations in elective and non-elective major surgeries in patients with suboptimal Hb and/or inflammatory disease. Surgeons have a focus on “patient blood management”. Intravenous infusion of iron improves Hb concentrations and hematological response quickly and replenishes the iron stores. Subsequently also reduces treatment cost by decreasing blood transfusions and related complications.