Role of preoperative erythropoietin in the optimization of preoperative anemia among surgical patients — A systematic review and meta-analysis

Abstract Preoperative anemia is a common finding. Preoperative allogeneic transfusion, iron therapy, vitamin supplementation and erythropoietin therapy are the current management strategies for preoperative anemia. Previous reviews regarding erythropoietin were limited to specialties, provided little evidence regarding the benefits and risks of erythropoietin in managing preoperative anemia and included non-anemic patients. The purpose of our systematic review was to determine the role of erythropoietin solely in preoperatively anemic patients and to investigate the complications of this treatment modality to produce a guideline for preoperative management of anemic patients for all surgical specialties. The PubMed/Medline, Google Scholar, and Cochrane Library were searched for randomized trials evaluating the efficacy of erythropoietin in preoperative anemia. The risk ratio (RR) and standardized mean difference (SMD) was used to pool the estimates of categorical and continuous outcomes, respectively. Allogeneic transfusion and complications and the 90-day mortality were the primary outcomes, while the postoperative change in hemoglobin, bleeding in milliliters and the number of red blood cell (RBC) packs transfused were the secondary outcomes. Results: Eight studies were included, comprising 734 and 716 patients in the erythropoietin group and non-erythropoietin group, respectively. The pooled estimate by RR for allogeneic transfusion was 0.829 (p = 0.049), while complications and the 90-day mortality were among the 1,318 (p = 0.18) patients. Conclusion: Preoperative erythropoietin provides better outcomes, considering the optimization of preoperative anemia for elective surgical procedures. The benefits of erythropoietin are significantly higher, compared to the control group, while the risks remain equivocal in both groups. We recommend preoperative erythropoietin in anemic patients.

Anemia, insuficiência cardíaca e manejo clínico baseado em evidências / Anemia, heart failure and evidence-based clinical management

A anemia é uma comorbidade prevalente e marcadora de pior prognóstico em pacientes com insuficiência cardíaca (IC). Sua relevância clínica, bem como a fisiopatologia e abordagem terapêutica nesses pacientes são temas de destaque na literatura especializada. Nessa revisão são descritos os conceitos atuais sobre a fisiopatologia da anemia na IC, os critérios diagnósticos e as indicações da suplementação de ferro, ao mesmo tempo em que são analisados criticamente os principais estudos que ofereceram evidências sobre os benefícios dessa suplementação. São abordados os quatro componentes principais da anemia: doença crônica, dilucional, "renal" e disabsortiva. Nos pacientes com IC, os critérios para o diagnóstico são os mesmos utilizados na população geral: níveis de ferritina sérica inferiores a 30 mcg/L em pacientes não nefropatas e menores que 100 mcg/L ou ferritina sérica entre 100-299 mcg/L com saturação de transferrina menor que 20% em pacientes com doença renal crônica. Finalmente, são discutidas as possibilidades terapêuticas da anemia nessa população específica de pacientes.

Anemia is a prevalent comorbidity and marker of a poorer prognosis in patients with heart failure (HF). Its clinical relevance, as well as its pathophysiology and the clinical management of these patients are important subjects in the specialized literature. In the present review, we describe the current concepts on the pathophysiology of anemia in HF, its diagnostic criteria, and the recommendations for iron supplementation. Also, we make a critical analysis of the major studies showing evidences on the benefits of this supplementation. The four main components of anemia are addressed: chronic disease, dilutional, "renal" and malabsorption. In patients with HF, the diagnostic criteria are the same as those used in the general population: serum ferritin levels lower than 30 mcg/L in patients without kidney diseases and lower than 100 mcg/L or serum ferritin levels between 100-299 mcg/L with transferring saturation lower than 20% in patients with chronic kidney diseases. Finally, the therapeutic possibilities for anemia in this specific patient population are discussed.

Are we really making motherhood safe? A study of provision of iron supplements and emergency obstetric care in rural Maharashtra.

BACKGROUND: The Government of India launched the National Rural Health Mission (NRHM) in 2005 to improve healthcare delivery and strengthen the public health system. Prevention and management of anaemia during pregnancy and access to quality emergency obstetric care services are important factors in reducing maternal mortality, which is a priority goal in the NRHM. We studied the ground realities specific to the availability of maternity services in the public health system of Maharashtra. METHODS: The study was done in the rural areas of Ahmednagar district in Maharashtra in 2006. Data regarding the number and place of deliveries, and details regarding iron supplements received and used were collected from 14 primary health centres selected by a stratified random method. Data regarding the number of caesarean section operations conducted in 3 selected rural hospitals and the availability of iron supplements at the district headquarters were also obtained. Three questionnaires were used in the format prescribed under the Right to Information Act of the Government of India, 2005. RESULTS: No iron supplement was available during the entire year in 21% of primary health centres. Iron supplements were available for 1-4 months, 5-8 months and 9-11 months, in 4, 3 and 4 primary health centres, respectively. The district headquarters did not receive supplies of iron supplements during the year from higher authorities. No caesarean sections were done in any of the selected rural hospitals during 2006. The proportion of deliveries that took place in primary health centres and subcentres, at home, and at private healthcare facilities was 1:1.5:5. CONCLUSION: Essential supplies such as iron supplements are in short supply and emergency obstetric care services are nonexistent in the public health system in our study area. The NRHM needs to address the ground realities to make motherhood safe.