Abstract
Anemia, iron deficiency and other hematinic deficiencies are a major cause of perioperative transfusion needs and are associated with increased morbidity and mortality. Anemia can be caused either by decreased production of hemoglobin or red blood cells or by increased consumption and blood loss. Decreased production can involve anything from erythropoietin or vitamin B12 insufficiency to absolute or functional lack of iron. Thus, to achieve the goal of patient blood management, anemia must be addressed by addressing its causes. The traditional parameters to diagnose anemia, despite offering elaborate options, are not ideally suited to giving a simple overview of the causes of anemia, e.g., iron status for erythropoiesis, especially during the acute phase of inflammation, acute blood loss or iron deficiency. Reticulocyte hemoglobin can thus help to uncover the cause of the anemia and to identify the main factors inhibiting erythropoiesis. Regardless of the cause of anemia, reticulocyte hemoglobin can also quickly track the success of therapy and, together with the regular full blood count it is measured alongside, help in clearing the patient for surgery.
Highlights
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Iron deficiency is a major cause of preoperative anemia
Any blood loss because of surgery only exacerbates the problem, leading to postoperative anemia being even more common [11,12] and iron deficiency at all stages leads to a higher risk of complications
Summary
“Patient Blood Management” (PBM) and “Enhanced Recovery After Surgery” (ERAS) concepts are systematic quality improving clinical models. The ERAS concept is a set of evidence-based practices which aim to optimize outcome, reduce patient surgical stress response, and improve recovery after surgery [1,2,3]. ERAS strives to optimize each patient’s condition, from preoperative, intraoperative and postoperative hospital intensive care treatment all the way to the post-discharge phase. This is achieved through patient education, preparation, and physiological optimization, including additional medical interventions as needed. ERAS can reduce morbidity by 50% and length of stay by 2.5 days, without an increase in readmissions [6]. This is beneficial for the patient, and helps reduce costs and save resources, without cutting corners or putting patients at risk
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