Pre-operative anaemia

B. Clevenger, T. Richards

Research output: Contribution to journalReview article

44 Citations (Scopus)

Abstract

Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

Original languageEnglish
Pages (from-to)20-28, e6-e8
Number of pages12
JournalAnaesthesia
Volume70
Issue numberSupplement 1
DOIs
Publication statusPublished - 1 Jan 2015
Externally publishedYes

Fingerprint

Anemia
Iron
Gastrointestinal Tract
Iron-Deficiency Anemias
Blood Transfusion
Length of Stay
Chronic Disease
Iron-Regulatory Proteins
Hepcidins
Ferritins
Disease Management
Biological Availability
Bone Marrow
Inflammation
Incidence

Cite this

Clevenger, B., & Richards, T. (2015). Pre-operative anaemia. Anaesthesia, 70(Supplement 1), 20-28, e6-e8. https://doi.org/10.1111/anae.12918
Clevenger, B. ; Richards, T. / Pre-operative anaemia. In: Anaesthesia. 2015 ; Vol. 70, No. Supplement 1. pp. 20-28, e6-e8.
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Clevenger, B & Richards, T 2015, 'Pre-operative anaemia' Anaesthesia, vol. 70, no. Supplement 1, pp. 20-28, e6-e8. https://doi.org/10.1111/anae.12918

Pre-operative anaemia. / Clevenger, B.; Richards, T.

In: Anaesthesia, Vol. 70, No. Supplement 1, 01.01.2015, p. 20-28, e6-e8.

Research output: Contribution to journalReview article

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Clevenger B, Richards T. Pre-operative anaemia. Anaesthesia. 2015 Jan 1;70(Supplement 1):20-28, e6-e8. https://doi.org/10.1111/anae.12918