Transfusion medicine

A large study just published in the journal Anaesthesia raises important questions about the way anemia is currently managed in surgical patients (Associations of nadir hemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties: a retrospective cohort study). Professor Jeffery Hamdorf; Winthrop Professor of Surgical Education at The University of Western Australia and Chairman of the Western Australia Patient Blood Management Group; commented.

Medical community

Anemia (lower than normal levels of hemoglobin in the blood) is associated with adverse patient outcomes. Because Transfusion has been the traditional treatment for moderate to severe anemia; with the patient’s hemoglobin level being the primary consideration in the decision to transfuse. Questions, though; have been raised within the medical community in recent years about the effectiveness of transfusion (Appropriateness of Allogeneic Red Blood Cell Transfusion: The International Consensus Conference on Transfusion Outcomes).

Researchers from The University of Western Australia looked at over 60,000 patients undergoing surgery to determine if there is a level of anemia where transfusion is effective. Therefore After adjusting for patient risk factors; they find that transfusion is not reduce the risk of death at any level of anemia and is associate with longer hospital stays.

Patient Blood Management

Study co-author Shannon Farmer, Adjunct Research Fellow at the University of Western Australia and Scientific Associate of the International Foundation for Patient Blood Management; said: Improved management of patients’ anemia has become an important focus in the global uptake of patient blood management (PBM) programs.

A landmark study evaluating the results of the world’s first health-system-wide PBM program reported fewer deaths and complications; and shorter hospital stays with this approach (Improved outcomes and reduced costs associated with a health‐system wide patient blood management program: a retrospective observational study in four major adult tertiary‐care hospitals).

The current study highlights the urgent need for a greater focus on preventing the development of anaemia and; when it does develop; exploring more appropriate methods of managing it.  Therefore A recent editorial in the journal Annals of Surgery stated; “not implementing patient blood management represents substandard care. Because ” The purpose of establishing the etiology of an anemia is to permit selection of a specific and effective therapy. For example; corticosteroids are useful in the treatment of autoimmune hemolytic anemia.

Hereditary disorders

Therapy and medical care vary considerably in the group of hereditary disorders. Splenectomy has been advantageous in hereditary spherocytosis and hereditary elliptocytosis, in some of the unstable hemoglobinopathies; and in certain patients with pyruvic kinase deficiency. Therefore It has little value in most other hereditary hemolytic disorders.
Drugs and chemicals capable of producing aplasia or a maturation arrest of erythroid precursors should be discontinued or avoided. Similarly, diseases know to be associate with anemia should be appropriately treat. Because Guidelines for the treatment of chemotherapy-associate anemia are available.