De rol van reticulocyten bij preoperatieve anemie

Abstract

The significance of reticulocytes in preoperative anemia While a blood transfusion can be a life-saving therapy in patients with severe anemia or active bleeding, it also exposes the patient to multiple safety risks and it represents a significant cost to society. As a result, more restrictive transfusion guidelines have been on the rise in recent years and the concept of ‘patient blood management’ (PBM) was created. PBM is a multidisciplinary and patient-oriented strategy that focuses on one’s own blood instead of allogeneic blood with the ambition to reduce the number of blood transfusions worldwide. Optimizing the erythropoiesis is the first of the 3 pillars of PBM. Diagnosing and treating preoperative anemia belong to this category. Various known laboratory parameters are contributing to the anamnesis and clinical examination, such as hemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), reticulocytes, iron parameters, vitamin B12 and folic acid. The company Sysmex, owner of the most widely used hematological analyzers in Belgium, also introduced less well-known red blood cell indices related to the reticulocytes. Several parameters, such as the reticulocyte production index (RPI), the reticulocyte hemoglobin equivalent (RET-He), delta hemoglobin (Delta-He) and the percentage of hypochromic red blood cells (Hypo-He), are gradually finding their way into anemia management. The second pillar of PBM deals with minimizing blood loss. The third pillar focuses on assessing and optimizing the patient’s tolerance for anemia. This article pays particular attention to the preoperative part of the first pillar. A guideline for diagnosing and treating preoperative anemia using various reticulocyte parameters was created.