Sunday, March 18, 2012

Preoperative anemia optimization - the role of intravenous iron in the XXI century

Intravenous iron was first used in the first half of the XX century until the decade of the 70's when it was essentially considered as a very dangerous drug with substantial potential for anaphylaxis. 

The fear prevailed for 2 decades, until the decade of the 90's when a closer look into alternatives to blood transfusion, and a desire to provide a safer medicine yielded into exploration and revision of intravenous iron as a potential therapeutic agent. In the early years of last decade, the FDA showed that even the high molecular weight dextrans were associated with a very small risk of adverse effects as well as a substantially lower cost compared with blood transfusions.

A surge in a safer practice of Medicine has blossomed in the past decade, including the famous publication of "To Err is human" from the Institute of Medicine, as well as multiple endeavors from a variety of government and private institutions, creating a real-time awareness of the need to change our practices with a safer, conservative and parsimonious use of resources as well as attention to detail. 

Among these practices, it is the practice of blood management. I won't go into deep details, however, must say that in surgical patients, it is well known that preoperative anemia is a risk factor for poor outcomes.

In this article at the ACP Hospitalist, we provide an insight on the utilization of intravenous iron as a treatment to optimize preoperative anemia and ensure that patients' preoperative hemoglobin rises enough so that after surgical blood loss, the postoperative hemoglobin levels won't reach the transfusion threshold.

We have been building experience in our institution with a substantial decrease in perioperative allogenic blood transfusion utilization, promoting patient safety and improved quality of care, obeying our medical mantra.....primum non nocere. 

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