INTRODUCTION OF A PREOPERATIVE ANAEMIA CLINIC IMPROVES PERI-OPERATIVE TRANSFUSION USE
(Abstract release date: 05/19/16)
EHA Library. Cader R. 06/12/16; 135329; S835
Dr. Ruzaika Cader
Contributions
Contributions
Abstract
Abstract: S835
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:30 - 08:45
Location: Room H6
Background
Preoperative anaemia is a potentially modifiable risk factor for perioperative morbidity and mortality. Strategies for anaemia correction have been outlined by the UK Joint Blood and Transplant Professional Advisory Committee, the 2015 NICE (National Institute of Clinical Excellence) guidelines for blood transfusion and a guideline by the British Committee for Standards in Haematology. Here we present the results of a pilot study, where we introduced a preoperative clinic aimed at correcting treatable anaemia without delaying cardiac surgery at Papworth hospital, UK.
Aims
The aims of this study were to evaluate whether introduction of a pre-operative anaemic clinic improves patient blood management or clinical outcome following major cardiac surgery.
Methods
All patients listed for major cardiac surgery between May to December 2015, Papworth Hospital, UK were screened for anaemia at surgical pre assessment clinic. 107 patients with a haemoglobin <130 g/l (males) and <120g/l (females) were recruited and underwent further testing for ferritin, vitamin B12, plasma folate, creatinine and TSH. Patients were then reviewed at clinic by a consultant haematologist, who decided upon appropriate anaemia management. 25 patients with a ferritin level <100g/L received 1g of Ferinject® (Fe-Carboximaltose) as a single dose infusion up to 6 weeks preoperatively. For another 23 patients the above ferritin criterion was met, but for a variety of reasons preoperative iron could not be administered. 4 patients received oral iron. The remaining patients were advised to commence B12, folate or combinations thereof or proceeded to surgery in the absence of a treatable cause of anaemia. We collected information on blood products administered, total hospital stay, intensive care stay and mortality. Data were compared to a previously published historic control group of anaemia patients undergoing cardiac surgery (n=165;Pap60) and compared by t-test.
Results
Patients assessed in the preoperative anaemia clinic received significantly less red cell transfusion than patients proceeding directly to surgery in the Pap60 study (2.2 ± 3.2 units vs 3.9 ± 4.0 units; mean ± S.D., p=0.027) and had significantly shorter hospital stay (12.9 ± 10.6 days vs 16.0 ± 9.9 days; mean ± S.D., p<0.01). However there was no difference in transfusion use or hospital stay between iron treated and non-iron treated, low ferritin patient subgroups, nor were these significantly different in comparison to the whole anaemia clinic cohort.
Conclusion
In conclusion, we have found that our preoperative anaemia clinic improves overall patient blood management in the peri-operative period with a reduction in blood transfusion usage. However intravenous iron when given in the context of major cardiac surgery seems to have no additional benefit in this pilot study.
Session topic: Transfusion Medicine
Keyword(s): Anemia, Blood transfusion
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:30 - 08:45
Location: Room H6
Background
Preoperative anaemia is a potentially modifiable risk factor for perioperative morbidity and mortality. Strategies for anaemia correction have been outlined by the UK Joint Blood and Transplant Professional Advisory Committee, the 2015 NICE (National Institute of Clinical Excellence) guidelines for blood transfusion and a guideline by the British Committee for Standards in Haematology. Here we present the results of a pilot study, where we introduced a preoperative clinic aimed at correcting treatable anaemia without delaying cardiac surgery at Papworth hospital, UK.
Aims
The aims of this study were to evaluate whether introduction of a pre-operative anaemic clinic improves patient blood management or clinical outcome following major cardiac surgery.
Methods
All patients listed for major cardiac surgery between May to December 2015, Papworth Hospital, UK were screened for anaemia at surgical pre assessment clinic. 107 patients with a haemoglobin <130 g/l (males) and <120g/l (females) were recruited and underwent further testing for ferritin, vitamin B12, plasma folate, creatinine and TSH. Patients were then reviewed at clinic by a consultant haematologist, who decided upon appropriate anaemia management. 25 patients with a ferritin level <100g/L received 1g of Ferinject® (Fe-Carboximaltose) as a single dose infusion up to 6 weeks preoperatively. For another 23 patients the above ferritin criterion was met, but for a variety of reasons preoperative iron could not be administered. 4 patients received oral iron. The remaining patients were advised to commence B12, folate or combinations thereof or proceeded to surgery in the absence of a treatable cause of anaemia. We collected information on blood products administered, total hospital stay, intensive care stay and mortality. Data were compared to a previously published historic control group of anaemia patients undergoing cardiac surgery (n=165;Pap60) and compared by t-test.
Results
Patients assessed in the preoperative anaemia clinic received significantly less red cell transfusion than patients proceeding directly to surgery in the Pap60 study (2.2 ± 3.2 units vs 3.9 ± 4.0 units; mean ± S.D., p=0.027) and had significantly shorter hospital stay (12.9 ± 10.6 days vs 16.0 ± 9.9 days; mean ± S.D., p<0.01). However there was no difference in transfusion use or hospital stay between iron treated and non-iron treated, low ferritin patient subgroups, nor were these significantly different in comparison to the whole anaemia clinic cohort.
Conclusion
In conclusion, we have found that our preoperative anaemia clinic improves overall patient blood management in the peri-operative period with a reduction in blood transfusion usage. However intravenous iron when given in the context of major cardiac surgery seems to have no additional benefit in this pilot study.
Session topic: Transfusion Medicine
Keyword(s): Anemia, Blood transfusion
Abstract: S835
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:30 - 08:45
Location: Room H6
Background
Preoperative anaemia is a potentially modifiable risk factor for perioperative morbidity and mortality. Strategies for anaemia correction have been outlined by the UK Joint Blood and Transplant Professional Advisory Committee, the 2015 NICE (National Institute of Clinical Excellence) guidelines for blood transfusion and a guideline by the British Committee for Standards in Haematology. Here we present the results of a pilot study, where we introduced a preoperative clinic aimed at correcting treatable anaemia without delaying cardiac surgery at Papworth hospital, UK.
Aims
The aims of this study were to evaluate whether introduction of a pre-operative anaemic clinic improves patient blood management or clinical outcome following major cardiac surgery.
Methods
All patients listed for major cardiac surgery between May to December 2015, Papworth Hospital, UK were screened for anaemia at surgical pre assessment clinic. 107 patients with a haemoglobin <130 g/l (males) and <120g/l (females) were recruited and underwent further testing for ferritin, vitamin B12, plasma folate, creatinine and TSH. Patients were then reviewed at clinic by a consultant haematologist, who decided upon appropriate anaemia management. 25 patients with a ferritin level <100g/L received 1g of Ferinject® (Fe-Carboximaltose) as a single dose infusion up to 6 weeks preoperatively. For another 23 patients the above ferritin criterion was met, but for a variety of reasons preoperative iron could not be administered. 4 patients received oral iron. The remaining patients were advised to commence B12, folate or combinations thereof or proceeded to surgery in the absence of a treatable cause of anaemia. We collected information on blood products administered, total hospital stay, intensive care stay and mortality. Data were compared to a previously published historic control group of anaemia patients undergoing cardiac surgery (n=165;Pap60) and compared by t-test.
Results
Patients assessed in the preoperative anaemia clinic received significantly less red cell transfusion than patients proceeding directly to surgery in the Pap60 study (2.2 ± 3.2 units vs 3.9 ± 4.0 units; mean ± S.D., p=0.027) and had significantly shorter hospital stay (12.9 ± 10.6 days vs 16.0 ± 9.9 days; mean ± S.D., p<0.01). However there was no difference in transfusion use or hospital stay between iron treated and non-iron treated, low ferritin patient subgroups, nor were these significantly different in comparison to the whole anaemia clinic cohort.
Conclusion
In conclusion, we have found that our preoperative anaemia clinic improves overall patient blood management in the peri-operative period with a reduction in blood transfusion usage. However intravenous iron when given in the context of major cardiac surgery seems to have no additional benefit in this pilot study.
Session topic: Transfusion Medicine
Keyword(s): Anemia, Blood transfusion
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:30 - 08:45
Location: Room H6
Background
Preoperative anaemia is a potentially modifiable risk factor for perioperative morbidity and mortality. Strategies for anaemia correction have been outlined by the UK Joint Blood and Transplant Professional Advisory Committee, the 2015 NICE (National Institute of Clinical Excellence) guidelines for blood transfusion and a guideline by the British Committee for Standards in Haematology. Here we present the results of a pilot study, where we introduced a preoperative clinic aimed at correcting treatable anaemia without delaying cardiac surgery at Papworth hospital, UK.
Aims
The aims of this study were to evaluate whether introduction of a pre-operative anaemic clinic improves patient blood management or clinical outcome following major cardiac surgery.
Methods
All patients listed for major cardiac surgery between May to December 2015, Papworth Hospital, UK were screened for anaemia at surgical pre assessment clinic. 107 patients with a haemoglobin <130 g/l (males) and <120g/l (females) were recruited and underwent further testing for ferritin, vitamin B12, plasma folate, creatinine and TSH. Patients were then reviewed at clinic by a consultant haematologist, who decided upon appropriate anaemia management. 25 patients with a ferritin level <100g/L received 1g of Ferinject® (Fe-Carboximaltose) as a single dose infusion up to 6 weeks preoperatively. For another 23 patients the above ferritin criterion was met, but for a variety of reasons preoperative iron could not be administered. 4 patients received oral iron. The remaining patients were advised to commence B12, folate or combinations thereof or proceeded to surgery in the absence of a treatable cause of anaemia. We collected information on blood products administered, total hospital stay, intensive care stay and mortality. Data were compared to a previously published historic control group of anaemia patients undergoing cardiac surgery (n=165;Pap60) and compared by t-test.
Results
Patients assessed in the preoperative anaemia clinic received significantly less red cell transfusion than patients proceeding directly to surgery in the Pap60 study (2.2 ± 3.2 units vs 3.9 ± 4.0 units; mean ± S.D., p=0.027) and had significantly shorter hospital stay (12.9 ± 10.6 days vs 16.0 ± 9.9 days; mean ± S.D., p<0.01). However there was no difference in transfusion use or hospital stay between iron treated and non-iron treated, low ferritin patient subgroups, nor were these significantly different in comparison to the whole anaemia clinic cohort.
Conclusion
In conclusion, we have found that our preoperative anaemia clinic improves overall patient blood management in the peri-operative period with a reduction in blood transfusion usage. However intravenous iron when given in the context of major cardiac surgery seems to have no additional benefit in this pilot study.
Session topic: Transfusion Medicine
Keyword(s): Anemia, Blood transfusion
{{ help_message }}
{{filter}}