Blood Transfusion - 1 2012 (January - March)
On the role of iron therapy for reducing allogeneic blood transfusion in orthopaedic surgery
Authors:  Manuel Muñoz, José Antonio García-Erce, Jorge Cuenca, Elvira Bisbe, Enrique Naveira, AWGE (Spanish Anaemia Working Group)
Pages:  8-22
To cite this article:  Blood Transfus 2012; 10: 8-22
Doi:  10.2450/2011.0061-11
Published online:  30/11/2011

The prevalence of pre-operative anaemia may be high among surgical patients, depending on the patients' co-morbidities, gender, age and the underlying pathology for which they require surgery. In this regard, a recent systematic review showed that the weighted mean prevalence of anaemia was 24% in patients undergoing elective knee or hip surgery and 45% in those undergoing surgery because of a hip fracture1. In addition, it is worth noting that the proportion of older patients who undergo major orthopaedic surgery is rising progressively, and a high prevalence of anaemia (43%) was observed in a retrospective cohort of 57,636 veterans aged 65 years or older who underwent major elective and non-elective orthopaedic surgery2.
Iron deficiency and chronic inflammation (including mild to moderate renal failure), with or without iron deficiency, are the most common causes of pre-operative anaemia, although deficiencies of iron, folic acid and/or vitamin B12 without anaemia are also frequent, especially among an elderly population. Saleh et al.3 reported that 19.6% (210/1,142) of admissions for elective total knee or hip replacement were anaemic compared with local population reference ranges (males 13 g/dL; females, 11.5 g/dL), with 76 of these anaemic patients having a haemoglobin (Hb) <11 g/dL and 13 having a Hb <10 g/dL. Regarding the types of anaemia, 135 had normocytic normochromic anaemia, 49 showed hypochromic varieties of anaemia, and 26 were classified as having other types of anaemia (...).
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