Background Preoperative haemoglobin (P-Hb) optimisation through the identification and treatment of anaemia is used with the aim of reducing the need for peri/postoperative blood transfusions.
Purpose To verify the adaptation to a protocol of ‘Preparatory Iron-deficiency Anaemia Diagnostic and Treatment’ in patients presenting with moderate/severe haemorrhagic risk surgery (MSHRS), included in a rapid-route.
Material and methods Retrospective observational study of patients in a second-level hospital between December 2015 and March 2016.
In patients with P-Hb <13 mg/dL, ferritin levels and haemoglobin reticulocyte content (RHC) should be determined by the Clinical Analysis Department to discriminate iron deficiency anaemia. Patients going to MSHRS (colorectal cancer and radical cistectomy) with iron deficiency confirmed, were prescribed from preanaesthesia consultation: ferric carboxymaltose (FC); 1 g, folic acid; 5 mg orally/day and cyanocobalamin; and 1 mg subcutaneous/week.
The Pharmacy Department receives a request form to provide FC for those patients with P-Hb <13 mg/dL included in RRSP for immediate hospital administration. If ferritin levels are not available, serum iron levels, iron fixation capacity and transferrin saturation (reference values: 50–170 mcg/dL, 250–450 mcg/dL and 15%–50%, respectively) were revieved.
Results Thirty-seven patients initially included in RSSP. Four patients excluded (admitted (n=2), pending preanaesthesia consultation (n=2)). Median age: 71 years’ old (63.6% male). Diagnoses: colorectal cancer (n=27), gastric cancer (n=3); pancreatic cancer (n=1), esophageal cancer (n=1), and cholangiocarcinoma (n=1).
Eighteen patients had a P-Hb <13 mg/dL. Median age: 73.4 years’ old (55.5% male). Fourteen of them have received: FC, folic acid and cyanocobalamin. Diagnoses: colorectal cancer (n=13), gastric cancer (n=1). No patients had ferritin levels or CHR. The median serum iron levels were: 53.9 mcg/dL (range: 17–295), iron fixation capacity: 367.1 mcg/dL (range: 293–454) and transferrin saturation: 14.1% (range: 5–69). Four patients required blood transfusions (median 3.5 red-cell-concentrates/patient).
Conclusion In view of the results, the protocol is not being adequately met: inclusion of patients with different diagnoses of MSHRS were included, and no determination of ferritin levels and RHC. This study detects deficiencies in our programme to establish improvement measures.
The small number of patients included does not allow us to draw conclusions about preoperative FC administration effectiveness in reducing the number of transfusions in this population.
References and/or Acknowledgements We thank the Haematology Department for their support
No conflict of interest
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