Preoperative strategies to minimise blood loss

Preoperative strategies to minimise blood loss

  • Issue 70

One of the Sunday’s sessions at this year’s Euroanaesthesia discussed the issues of anaemia and blood loss and the various preoperative strategies available to minimise the problem. The session began with a talk on ‘Preoperative strategies to own red cell mass’ by Dr Jens Meier, Department of Anaesthesiology and Intensive Care Medicine, Kepler University Hospital, Linz, Austria.

As Dr Meier pointed out: “Preoperative anaemia is a common problem. Depending on the country and the surgical intervention, 25% of patients are anaemic.” The situation is further complicated by the fact that most of these patients are not even aware that they have a problem since their anaemia is of mild or moderate severity, and may not present obvious symptoms.

Preoperative anaemia is a serious medical problem but Dr Meier said: “Physicians tend to neglect preoperative anaemia, since it is still not common sense that preoperative anaemia is an important symptom.” Despite their being a number of promising ways to treat the condition, these are rarely used due to the difficulty of implementing a programme to optimise preoperative red blood cell mass.

Dr Meier’s talk addressed the prevalence of preoperative anaemia and its impact on surgical outcomes. He also described a recently developed algorithm to guide treatment of the condition, and demonstrated the efficacy and safety of the two methods (iron/EPO treatment) that are frequently used in clinical practice.

He was followed by Dr Christian von Heymann whose talk was on “‘Preoperative anaemia and postoperative outcome’. Dr von Heymann is a Professor of Anaesthesiology and Intensive Care Medicine appointed at the Charité – Medical Faculty of the Humboldt-University of Berlin and is Head of the Department of Anaesthesiology, Intensive Care and Emergency Medicine at the Vivantes Klinikum im Friedrichshain, a large tertiary care hospital, in the centre of Berlin, Germany. His main research interests are preoperative anaemia, clotting and bleeding disorders in surgery and intensive care medicine, as well as bleeding and blood conservation in cardiac surgery. He has authored more than 100 peer-reviewed publications in these fields.

As Dr von Heymann pointed out: “Any disease that affects the synthesis of haemoglobin or affects the number of red blood cells may cause anaemia. The main causes for anaemia worldwide are iron and nutritional deficiencies (folic acid, vitamin B12), acute and chronic blood losses, chronic inflammation and disease (chronic renal insufficiency), acute and chronic infections (parasites and worms).”

He continues: “In the preoperative period, anaemia may be either a symptom of the comorbidities and the general health status of the patient, or due to a certain pathology.” Fortunately, preoperative anaemia is a treatable, or at least relievable risk factor in the majority of patients. Dr von Heymann said: “Large observational studies suggest that the untreated preoperative anaemia is associated with adverse short and long term outcomes. In particular, the severity of anaemia prior to surgery seems to play a crucial role as profound anaemia with a haemoglobin below 10 g/dl linked to the worst outcomes.

He then suggested that future research and studies should address whether a cause-related preoperative treatment of anaemia will benefit patients, and assess the role that transfusion of allogeneic red blood cells could play in this approach.