Journal articles: 'Pre-operative anaemia'

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Clevenger, B., and T. Richards. "Pre-operative anaemia." Anaesthesia 70 (December 1, 2014): 20—e8. http://dx.doi.org/10.1111/anae.12918.

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Gombotz, Hans. "9 Pre-operative anaemia and polycythaemia." Baillière's Clinical Anaesthesiology 12, no. 3 (September 1998): 451–69. http://dx.doi.org/10.1016/s0950-3501(98)80063-9.

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Kalio DGB, Eli S, Okagua KE, and Allagoa DO. "Prevalence of post-operative anaemia in surgical patients at the Rivers State University Teaching Hospital." World Journal of Advanced Research and Reviews 10, no. 1 (April 30, 2021): 218–23. http://dx.doi.org/10.30574/wjarr.2021.10.1.0149.

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Background: Post-operative anaemia is often a reflection of pre-operative pre-operative work-up and pre-operative anaemia. In addition. Post-operative anaemia is also determined by co-morbidities of patients prior to surgery. The prevalence of post-operative anaemia varies based on surgical specialties and the experience of the surgeon; prevalence rates as high as 85% have been recorded in orthopaedic surgeries. Aim: To determine the prevalence of post-operative anaemic in surgical patients at the Rivers State University Teaching Hospital (RSUTH). Method: This was a six months cross sectional study of the post-operative anaemia of patients who had operation at the Surgery and Obstetrics/Gyaecology departments of The Rivers State University Teaching Hospital. The permission for the study was granted by the head of department of obstetrics and gynaecology in conjunction with the head of .the hospital management. The yard stick for anaemia was packed cell volume less than 33% in line with the World Health Organization (WHO). A structured proforma was used to obtain information from patient’s case notes and analyzed using SPSS version 25. Result: Three hundred and eigthy subjects were recruited for the study. Males subjects were 150 (39.5%) while females were 230 (60.5%) respectively. The mean age was 31 years. One hundred and ninety nine (52.4%) were obstetrics and gynaecological surgeries while 181 (47.6 %) were non-gynaecological surgeries. The commonest indication for surgery was caesarean section representing 130 (34.2%) of the subjects. Two hundred and sixty six of the subjects (70%) had PCV less than 33%. One hundred and fifty two (40%) women had PCV less than 33% while 114 (30%) of the men had PCV less than 33%. Conclusion: The study revealed that prevalence of post-operative anaemia amongst surgical patients at RSUTH was 70 %. The post-operative anaemia amongst women was worrisome. The need to optimize patients prior to surgery cannot be over-emphasized to prevent morbidities and mortalities post-operative.

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Raha, Sanjay Kumar, Smriti Kana Biswas, Sorower Hossain, Md Salahuddin Rahaman, Khan Muhammad Fahim Bin Enayet, and Md Kamrul Hasan. "The Impact of Preoperative Anaemia on Early Outcomes after Off-pump Coronary Artery Bypass Grafting." Bangladesh Heart Journal 36, no. 1 (September 20, 2021): 47–54. http://dx.doi.org/10.3329/bhj.v36i1.55517.

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Introduction: In cardiac surgery, anaemia itself or combined with other risk factors has been found to be a major predictor for adverse outcome both preoperatively and postoperatively and even during extracorporeal circulation, but data about the specific tolerance of Coronary Artery Bypass Graft (CABG) patients for anaemia are conflicting and may in part be confounded by the effects of bypass surgery. Objectives: This study was performed in the National Institute of Cardiovascular Diseases (NICVD) to observe whether the early outcomes of Off-Pump CABG (OPCAB)were affected by pre-operative haematocrit levels. Methods: A total of 200 patients who underwent isolated OPCAB between January 2015 and December 2020 were retrospectively selected and purposively allocated into two groups: a)100 patients having preoperative anaemia and b) 100 patients without preoperative anaemia. Preoperative, per-operative and early post-operative variables were recorded, compiled and compared. Results: Preoperative characteristics were homogenously distributed between two groups other than haemoglobin level. Female patients had lower haemoglobin in each group. More patients of anaemic group required intraoperative and postoperative blood transfusion. The amount of blood loss and transfused blood products was also higher in anaemic patients. The ventilation time, length of ICU and post-operative hospital stay were significantly higher among anaemic patients. Among the post-operative complications, only the incidence of renal dysfunction was significantly higher among anaemic patients. Conclusion:This study has showed that anaemic patients undergoing OPCAB had an increased risk of postoperative adverse events. Importantly, the extent of preexisting comorbidities substantially affected perioperative anaemia tolerance. Therefore, preoperative risk assessment, optimization and subsequent therapeutic strategies, such as blood transfusion, should take into account both the individual level of preoperative haemoglobin and the extent of concomitant risk factors. Bangladesh Heart Journal 2021; 36(1) : 47-54

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Quinn, Martha, Robert J. Drummond, Fiona Ross, Juliette Murray, John Murphy, and Angus Macdonald. "Short course pre-operative ferrous sulphate supplementation – is it worthwhile in patients with colorectal cancer?" Annals of The Royal College of Surgeons of England 92, no. 7 (October 2010): 569–72. http://dx.doi.org/10.1308/003588410x12699663904277.

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INTRODUCTION Pre-operative anaemia is well recognised in patients presenting with colorectal cancer (CRC). While the benefits of long-term FeSO4 supplementation on Fe deficiency anaemia are well established, it is not known if short-course supplementation (2–3 weeks) impacts significantly on pre-operative haemoglobin (Hb) levels. This study examines the impact of short-term, oral FeSO4 supplementation on patients undergoing surgery for CRC. PATIENTS AND METHODS All patients with CRC presenting to a single surgeon were included. At diagnosis, baseline Hb and blood film were checked on all patients who then received 200 mg tds of FeSO4. Haemoglobin was rechecked pre-operatively and daily postoperatively. Patients requiring pre-operative blood transfusions were excluded from analysis. RESULTS Between 1 January 2004 and 31 December 2006, 117 patients were identified, 14 of whom were excluded. Patients received a median of 39 days’ treatment with FeSO4. Fifty-eight (56.3%) patients were anaemic at presentation gaining a mean of 1.73 g/dl (P < 0.001) from short-course FeSO4 supplementation. Right-sided tumours (lower mean Hb at presentation; P = 0.008) responded more to FeSO4 when compared to left-sided tumours (P < 0.017). Increase in Hb was unrelated to pathological stage. The transfusion rate for all curative resections was 0.69 units/patient. For the historical cohort (patients undergoing curative resection between 1 January 2001 and 31 December 2003), the mean transfusion rate fell from 1.69 units/patient. CONCLUSIONS Routine short-course supplementation with iron offers improved pre-operative Hb prior to surgery in CRC, especially in right-sided lesions and those with presenting anaemia.

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Grant-Casey, John, and Karen Madgwick. "Assessment of Anaemia in elective pre-operative Orthopaedic patients." Nursing Standard 24, no. 50 (August 18, 2010): 43–46. http://dx.doi.org/10.7748/ns.24.50.43.s48.

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Grant-Casey, John, and Karen Madgwick. "Assessment of anaemia in elective pre-operative orthopaedic patients." Nursing Standard 24, no. 50 (August 18, 2010): 43–46. http://dx.doi.org/10.7748/ns2010.08.24.50.43.c7938.

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Love, G. J., and P. K. Rickhuss. "Does pre-operative dehydration mask anaemia in hip fracture?" Injury Extra 41, no. 12 (December 2010): 134. http://dx.doi.org/10.1016/j.injury.2010.07.420.

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White, Michelle C., Lydia Longstaff, and Peggy S. Lai. "Effect of Pre-operative Anaemia on Post-operative Complications in Low-Resource Settings." World Journal of Surgery 41, no. 3 (November 11, 2016): 644–49. http://dx.doi.org/10.1007/s00268-016-3785-6.

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Hoare, Timothy J. "Pre-operative haemoglobin estimation in paediatric ENT surgery." Journal of Laryngology & Otology 107, no. 12 (December 1993): 1146–48. http://dx.doi.org/10.1017/s0022215100125502.

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Estimation of haemoglobin is still undertaken routinely before ENT surgery in many centres despite evidence that it is unnecessary, traumatic and expensive. The haemoglobin was estimated of all 372 children about to undergo ENT surgery in a busy district general hospital over a one year period. No child was noted to be clinically anacmic, and no child had a haemoglobin of less than 9 g/dl. Of 18 children with a haemoglobin level of 10.5 or less, 10 had their operations postponed and eight did not. There were no complications in the latter group. We can find no published evidence that operating on children with mild anaemia is unsafe. Ceasing routine pre-operative haemoglobin estimation would safely save an estimated £9000 per year in our unit.

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Butcher, A., T. Richards, S. J. Stanworth, and A. A. Klein. "Diagnostic criteria for pre-operative anaemia-time to end sex discrimination." Anaesthesia 72, no. 7 (April 6, 2017): 811–14. http://dx.doi.org/10.1111/anae.13877.

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Rogers, BA, A. Cowie, C. Alcock, and JW Rosson. "Identification and Treatment of Anaemia in Patients Awaiting Hip Replacement." Annals of The Royal College of Surgeons of England 90, no. 6 (September 2008): 504–7. http://dx.doi.org/10.1308/003588408x301163.

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INTRODUCTION The correction of anaemia prior to total hip arthroplasty reduces surgical risk, hospital stay and cost. This study considers the benefits of implementing a protocol of identifying and treating pre-operative anaemia whilst the patient is on the waiting list for surgery. PATIENTS AND METHODS From a prospective series of 322 patients undergoing elective total hip arthroplasty (THA), patients identified as anaemic (haemoglobin (Hb) < 12 g/dl) when initially placed upon the waiting list were appropriately investigated and treated. Pre- and postoperative Hb levels, need for transfusion, and length of hospital stay were collated for the entire patient cohort. RESULTS Of the cohort, 8.8% of patients were anaemic when initially placed upon the waiting list for THA and had a higher transfusion rate (23% versus 3%; P < 0.05) and longer hospital stay (7.5 days versus 6.6 days; P < 0.05). Over 40% of these patients responded to investigation and treatment whilst on the waiting list, showing a significant improvement in Hb level (10.1 g/dl to 12.7 g/dl) and improved transfusion rate. CONCLUSIONS Quantifying the haemoglobin level of patients when initially placed on the waiting list helps highlight those at risk of requiring a postoperative blood transfusion. Further, the early identification of anaemia allows for the utilisation of the waiting-list time to investigate and treat these patients. For patients who respond to treatment, there is a significant reduction in the need for blood transfusion with its inherent hazards.

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Lichtenegger, P., J. Schiefer, A. Graf, G. Berlakovich, P. Faybik, D. M. Baron, and J. Baron‐Stefaniak. "The association of pre‐operative anaemia with survival after orthotopic liver transplantation." Anaesthesia 75, no. 4 (November 7, 2019): 472–78. http://dx.doi.org/10.1111/anae.14918.

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Sierakowski, K., Y. T. Wong, C. Delaney, P. Hakendorf, K. Missen, and J. I. Spark. "Pre-Operative Anaemia Predicts Poor Outcomes in Patients Undergoing Infra-Inguinal Bypass Surgery." World Journal of Cardiovascular Diseases 04, no. 12 (2014): 594–600. http://dx.doi.org/10.4236/wjcd.2014.412072.

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Boyd‐Carson, H., A. Shah, A. Sugavanam, J. Reid, S. J. Stanworth, and C. M. Oliver. "The association of pre‐operative anaemia with morbidity and mortality after emergency laparotomy." Anaesthesia 75, no. 7 (April 21, 2020): 904–12. http://dx.doi.org/10.1111/anae.15021.

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Liu, David, Michael Dan, and Natalie Adivi. "Blood Conservation Strategies in Total Hip and Knee Arthroplasty." Reconstructive Review 4, no. 4 (January 12, 2015): 39–45. http://dx.doi.org/10.15438/rr.4.4.85.

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Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

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Yow, L., M. Doohan, S. Russell, L. McKie, T. Diamond, D. Vass, M. Taylor, and C. Jones. "Liver resections and pre-operative anaemia: Optimising patients in the peri-operative settings to reduce morbidity and mortality." HPB 22 (2020): S279. http://dx.doi.org/10.1016/j.hpb.2020.04.196.

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Karkouti, K., P. Yip, C. Chan, L. Chawla, and V. Rao. "Pre-operative anaemia, intra-operative hepcidin concentration and acute kidney injury after cardiac surgery: a retrospective observational study." Anaesthesia 73, no. 9 (March 12, 2018): 1097–102. http://dx.doi.org/10.1111/anae.14274.

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Ke, Y. H., K. Y. Hwang, T. N. Thin, Y. E. Sim, and H. R. Abdullah. "The usefulness of non‐invasive co‐oximetry haemoglobin measurement for screening pre‐operative anaemia." Anaesthesia 76, no. 1 (June 27, 2020): 54–60. http://dx.doi.org/10.1111/anae.15171.

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Froessler, Bernd, Catalin Tufanaru, Alan Pearson, and Allan Cyna. "Effectiveness and efficiency of pre-operative anaemia management with intravenous iron: A systematic review." JBI Database of Systematic Reviews and Implementation Reports 10, Supplement (2012): 1–11. http://dx.doi.org/10.11124/jbisrir-2012-272.

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Medhi, Robin, Sonika Bawri, Chaitra S.K., Mansur Ahmed, and Asmita Mishra. "Efficacy and safety of pre-operative single dose parenteral tranexamic acid in moderately anaemic parturients undergoing caesarean section." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 8 (July 26, 2017): 3423. http://dx.doi.org/10.18203/2320-1770.ijrcog20173456.

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Background: Preoperative administration of Tranexamic acid (TXA) has been found to be effective in reducing the amount of blood loss following Caesarean section in low risk women. However, studies in high risk women such as women with anaemia, where blood loss needs to be minimised are scarce.Methods: An experimental case control study was conducted with a total of 174 patients with moderate anaemia undergoing CS in a teaching hospital. Study group consisting of 87 patients received pre-operative TXA 1g intravenously. Intra operative and up to 6hours postpartum blood loss was calculated in both the groups. Requirement of blood transfusions were noted. Data analysed using Graphpad Instat® 3 statistical software.Results: Present study showed statistically significant reduction in intraoperative and postoperative blood loss among patients who received TXA compared to control group. The blood loss from placental delivery till completion of the procedure was significantly lowered (304.02ml vs 393.36ml; p value <0.0001). Postoperative blood loss (from end of the procedure up to 6hrs postpartum) was 62.57ml in comparison to 85.40ml in control group (p value <0.0001). The total blood loss from the placental delivery up to 6 hours postpartum was significantly reduced in study group (366.59ml vs 478.76ml; p value <0.0001). There was significant reduction of blood transfusion in study group (RR: 0.20, 95% CI, 0.045-0.887), without immediate adverse effect on mothers and new-borns.Conclusions: Administration of TXA preoperatively causes significant decrease in blood loss and the need for blood transfusion in patients with moderate anaemia undergoing CS.

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Hashim, Mohamed Mourad, Akram Umair, and Margaret Coleman. "AB209. 239. An audit of pre-operative anaemia and associated blood transfusion in patients attending the pre-operative assessment clinic at University Hospital Limerick." Mesentery and Peritoneum 3 (February 2019): AB209. http://dx.doi.org/10.21037/map.2019.ab209.

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Meybohm, Patrick, Hendrik Kohlhof, Dieter Christian Wirtz, Ingo Marzi, Christoph Füllenbach, Suma Choorapoikayil, Maria Wittmann, et al. "Preoperative Anaemia in Primary Hip and Knee Arthroplasty." Zeitschrift für Orthopädie und Unfallchirurgie 158, no. 02 (September 18, 2019): 194–200. http://dx.doi.org/10.1055/a-0974-4115.

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Abstract Introduction Approximately one in three patients has untreated preoperative anaemia, which in turn is associated with an increased need for transfusion of allogenic red blood cell concentrates (RBC) and complications in the context of a surgical intervention. Here, the prevalence of preoperative and postoperative anaemia as well as their effects on transfusion rate, hospital length of stay and hospital mortality in primary hip and knee arthroplasty has been analysed. Methods From January 2012 to September 2018, 378,069 adult inpatients from 13 German hospitals were analysed on the basis of an anonymized registry. Of these, n = 10,017 patients had a hip and knee joint primary arthroplasty. The primary endpoint was the incidence of preoperative anaemia, which was analysed by the first available preoperative haemoglobin value according to the WHO definition. Secondary endpoints included in-hospital length of stay, number of patients with red blood cell concentrate transfusion, incidence of hospital-acquired anaemia, number of deceased patients, and postoperative complications. Results The preoperative anaemia rate was 14.8% for elective knee joint arthroplasty, 22.9% for elective hip joint arthroplasty and 45.0% for duo-prosthesis implantation. Preoperative anaemia led to a significantly higher transfusion rate (knee: 8.3 vs. 1.8%; hip: 34.5 vs. 8.1%; duo-prosthesis: 42.3 vs. 17.4%), an increased red blood cell concentrate consumption (knee: 256 ± 107 vs. 29 ± 5 RBC/1000 patients; hip: 929 ± 60 vs. 190 ± 16 RBC/1000 patients; duo-prosthesis: 1411 ± 98 vs. 453 ± 42 RBC/1000 patients). Pre-operative anaemia was associated with prolonged hospital stay (12.0 [10.0; 17.0] d vs. 11.0 [9.0; 13.0] d; p < 0.001) and increased mortality (5.5% [4.6 – 6.5%] vs. 0.9% [0.7 – 1.2%]; Fisher p < 0.001) compared to non-anaemic patients. In patients aged 80 years and older, the incidence of preoperative anaemia and thus the transfusion rate was almost twice as high as in patients under 80 years of age. Summary Preoperative anaemia is common in knee and hip primary arthroplasty and was associated with a relevant increase in red blood cell concentrate consumption. In the context of patient blood management, a relevant potential arises, especially in elective orthopaedic surgery, to better prepare elective patients, to avoid unnecessary transfusions and thus to conserve the valuable resource blood.

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Boralessa, H., DR Goldhill, K. Tucker, AJ Mortimer, and J. Grant-Casey. "National Comparative Audit of Blood Use in Elective Primary Unilateral Total Hip Replacement Surgery in the UK." Annals of The Royal College of Surgeons of England 91, no. 7 (October 2009): 599–605. http://dx.doi.org/10.1308/003588409x432464.

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INTRODUCTION Blood is a scarce and expensive product. Although it may be life-saving, in recent years there has been an increased emphasis on the potential hazards of transfusion as well as evidence supporting the use of lower transfusion thresholds. Orthopaedic surgery accounts for some 10% of transfused red blood cells and evidence suggests that there is considerable variation in transfusion practice. PATIENTS AND METHODS NHS Blood and Transplant, in collaboration with the Royal College of Physicians, undertook a national audit on transfusion practice. Each hospital was asked to provide information relating to 40 consecutive patients undergoing elective, primary unilateral total hip replacement surgery. The results were compared to indicators and standards. RESULTS Information was analysed relating to 7465 operations performed in 223 hospitals. Almost all hospitals had a system for referring abnormal pre-operative blood results to a doctor and 73% performed a group-and-save rather than a cross-match before surgery. Of hospitals, 47% had a transfusion policy. In 73%, the policy recommended a transfusion threshold at a haemoglobin concentration of 8 g/dl or less. There was a wide variation in transfusion rate among hospitals. Of patients, 15% had a haemoglobin concentration less than 12 g/dl recorded in the 28 days before surgery and 57% of these patients were transfused compared to 20% with higher pre-operative values. Of those who were transfused, 7% were given a single unit and 67% two units. Of patients transfused two or more units during days 1–14 after surgery, 65% had a post transfusion haemoglobin concentration of 10 g/dl or more. CONCLUSIONS Pre-operative anaemia, lack of availability of transfusion protocols and use of different thresholds for transfusion may have contributed to the wide variation in transfusion rate. Effective measures to identify and correct pre-operative anaemia may decrease the need for transfusion. A consistent, evidence-based, transfusion threshold should be used and transfusion of more than one unit should only be given if essential to maintain haemoglobin concentrations above this threshold.

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Potter, L. J., B. Doleman, and I. K. Moppett. "A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips." Anaesthesia 70, no. 4 (March 12, 2015): 483–500. http://dx.doi.org/10.1111/anae.12978.

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Ghoneima, Ahmed S., Karen Flashman, Victoria Dawe, Eleanor Baldwin, and Valerio Celentano. "High risk of septic complications following surgery for Crohn's disease in patients with preoperative anaemia, hypoalbuminemia and high CRP." International Journal of Colorectal Disease 34, no. 12 (November 8, 2019): 2185–88. http://dx.doi.org/10.1007/s00384-019-03427-7.

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Abstract Aim Bowel resection in Crohn's disease still has a high rate of complications due to risk factors including immune suppression, malnutrition and active inflammation or infection at the time of operating. In this study, we use serological levels and inflammatory markers to predict the potential of complications in patients undergoing resections for complicated Crohn's disease. Methods All patients undergoing laparoscopic bowel resection for Crohn’s disease from 5th of November 2012 to 11th of October 2017 were included in this retrospective observational study. Patients were divided into 4 groups scoring 0, 1, 2 or 3 depending on their pre-operative haemoglobin concentration (Hb), C-reactive protein (CRP) and albumin (Alb) where 1 point was given for an abnormal value in each as detailed in the definitions. They were then grouped into a low risk group comprised of those scoring 0 and 1, and a high risk group for those scoring 2 and 3 and data was collected to compare outcomes and the incidence of septic complications. Results Seventy-nine patients were included. Eleven (13.9%) and 2 (2.5%) patients had 2 or 3 abnormal values of CRP, Alb and Hb and were categorized as high risk. High risk patients had a significantly higher rate of post-operative septic complications (30.7%) compared with low risk patients (10.6%) p value < 0.0001. Conclusion Pre-operative CRP, haemoglobin and albumin can serve as predictors of septic complications after surgery for Crohn’s disease and can therefore be used to guide pre-operative optimisation and clinical decision-making.

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V., Semmalar G., Kaviya Anisha S. J., Terry Sheetal B., Saravanakumar R. T., and Latha K. "Study on drug profile used in common pregnancy influenced issues and its complications." International Journal of Basic & Clinical Pharmacology 10, no. 10 (September 23, 2021): 1196. http://dx.doi.org/10.18203/2319-2003.ijbcp20213751.

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Background: Pregnancy influenced issues are common among pregnant women treated by medications that causes complication in mother and fetus. The study aims to identify patients with pregnancy influenced issues like gestational diabetes mellitus, gestational hypertension, gastroesophageal reflux disease and anaemia. To assess the drug used pattern along with antibiotic therapy and to observe the above disease related complications.Methods: A hospital based prospective observational study was conducted at department of obstetrics and gynecology in Rajah Muthiah Medical College and Hospital. Totally 100 patients enrolled and data was collected using data collection form.Results: Out of 100 patients, high prevalence occurred in 26-30 years of age. Primarily gestational hypertension (39%), treated with Tab. Labetatol and complications were premature delivery, low birth weight. Anaemia (25%) cases treated with Tab. Ferrous sulphate, Iron sucrose and Folic Acid, Preterm delivery as complication. Gestational diabetes mellitus (18%) treated with Metformin and Human Insulin and complications were preterm delivery, maternal obesity, increased child weight. GERD (8%) treated with Pantoprazole, Ondansetron, Bifilac and complications were weight loss, dehydration, low birth weight. In pre-operative cases, 79% received antibiotics as monotherapy and 21% as dual therapy. In post-operative cases, 41% received antibiotics as monotherapy and 59% as dual therapy. Metronidazole (95%) given in both post and pre- operative conditions.Conclusions: The present study provides valuable insight about the overall drugs used in pregnancy related diseases and complications arise. We hope our data will make necessary recommendations to all health care professionals and pregnant women to ensure all pregnancy related safety measures were taken.

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Kotzé, Alwyn, Andrea Harris, Charles Baker, Tariq Iqbal, Nick Lavies, Toby Richards, Kate Ryan, Craig Taylor, and Dafydd Thomas. "British Committee for Standards in Haematology Guidelines on the Identification and Management of Pre-Operative Anaemia." British Journal of Haematology 171, no. 3 (September 6, 2015): 322–31. http://dx.doi.org/10.1111/bjh.13623.

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Cladellas, Mercè, Jordi Bruguera, Josep Comín, Joan Vila, Elisabeth de Jaime, Julio Martí, and Miquel Gomez. "Is pre-operative anaemia a risk marker for in-hospital mortality and morbidity after valve replacement?" European Heart Journal 27, no. 9 (March 14, 2006): 1093–99. http://dx.doi.org/10.1093/eurheartj/ehi830.

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Munting, K. E., and A. A. Klein. "Optimisation of pre-operative anaemia in patients before elective major surgery - why, who, when and how?" Anaesthesia 74 (January 2019): 49–57. http://dx.doi.org/10.1111/anae.14466.

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Hopper, Laura R., Mark A. Glaire, Majid Rashid, James G. Docherty, and Angus J. M. Watson. "Treatment of pre-operative anaemia in patients undergoing surgical management of colorectal cancer; a re-audit." International Journal of Surgery 12 (November 2014): S29. http://dx.doi.org/10.1016/j.ijsu.2014.07.113.

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Blaudszun, G., K. E. Munting, A. Butchart, C. Gerrard, and A. A. Klein. "The association between borderline pre-operative anaemia in women and outcomes after cardiac surgery: a cohort study." Anaesthesia 73, no. 5 (January 19, 2018): 572–78. http://dx.doi.org/10.1111/anae.14185.

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Sunil, Ariana Spungina. "Pre-operative anaemia and length of hospital stay following elective total hip replacement and total knee replacement." International Journal of Surgery 11, no. 8 (October 2013): 659. http://dx.doi.org/10.1016/j.ijsu.2013.06.387.

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Fortier, Julia, Shiyi Pang, Soleil Schutte, Marc Stuart Zumberg, and Anita Rajasekhar. "Use of cell salvage and HBOC-201 in a pregnant Jehovah’s Witness with sickle beta+thalassaemia undergoing emergency caesarean section." BMJ Case Reports 15, no. 11 (November 2022): e251368. http://dx.doi.org/10.1136/bcr-2022-251368.

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Patients with severe anaemia who refuse or cannot safely receive red cell transfusion present challenges during pregnancy, delivery and the postpartum period. Strategies including HBOC-201 (Hemopure) and intraoperative use of cell salvage have been used in non-pregnant patients to improve oxygen carrying capacity; however, these products pose unique risks in pregnant patients, those with sickle cell disease (SCD) and those undergoing caesarean section (C-section). We describe a case of a pregnant sickle beta+thalasasaemia patient who presented at 27 weeks gestation with pre-eclampsia and severe anaemia. As a Jehovah’s Witness, she declined allogenic blood transfusion. The patient successfully underwent emergent C-section with cell salvage and received HBOC-201 immediately after delivery, during the operative procedure. To our knowledge, this is the first published report documenting a Jehovah’s Witness patient with SCD who successfully received cell salvage and then HBOC-201 immediately postdelivery.

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Rössler, J., I. Hegemann, F. Schoenrath, B. Seifert, A. Kaserer, G. H. Spahn, V. Falk, and D. R. Spahn. "Efficacy of quadruple treatment on different types of pre‐operative anaemia: secondary analysis of a randomised controlled trial." Anaesthesia 75, no. 8 (April 27, 2020): 1039–49. http://dx.doi.org/10.1111/anae.15062.

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Zebari, Salih M. S., Nashwan Q. Mahgoob, Maryam N. Qahtan, Noorhan M. Jassim, Hafsa O. Adil, and Amenah Q. Hashim. "Pre and Early Post-Operative Iron Assessment in Obese Patients Underwent Laparoscopic Sleeve Gasterctomy." Cihan University-Erbil Scientific Journal 6, no. 2 (December 30, 2022): 153–60. http://dx.doi.org/10.24086/cuesj.v6n2y2022.pp153-160.

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Obesity is a chronic disease associated with mortality and morbidity. Bariatric surgery (BS) as a long-term weight reduction treatment has been increased. This study investigated the early state of iron storage and deficiency in patients underwent laparoscopic sleeve gastrectomy (LSG). Thirty patients were selected as a prospective study underwent LSG according to specialized inclusion and exclusion criteria at Soran Private Hospital in Erbil, from 1/1/2021 to 1/9/2021 after signing a consent form. All selected patients underwent preoperative and three months’ post-operative hemoglobin (Hb), mean corpuscular volume (MCV), and serum ferritin (SF) assessments. They were instructed to follow specialized diet regimen for three months’ post-operative and not to take any drugs and supplements. Results showed a strong positive correlation between preoperative and postoperative assessment for both Hb and MCV respectively (r= 0.72; P < 0.001), (r= 0.76; P < 0.001), and a moderate correlation for SF (r= 0.41; P < 0.024). Significant difference (P < 0.05) was found between preoperative and postoperative for the three markers (Hb, MCV and SF). Their values were decreased from preoperative to postoperative for the majority of the cases, but they were still within the normal range. The finding demonstrated that after three months from LSG, no patients showed iron deficiency anaemia. However, there was decrease in SF level which indicated that the storage capacity of iron was decreasing. This suggest that the iron supplement has to be started since the food regime followed in by the patients was not sufficient to maintain normal iron level.

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Sun, L., and Y. Feng. "Pre‐operative anaemia and postoperative acute kidney injury in liver transplantation: valuable but there are still some unanswered questions." Anaesthesia 75, no. 5 (April 12, 2020): 690. http://dx.doi.org/10.1111/anae.14981.

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Wong, W., J. Leong, and J. Rao. "A retrospective audit on pre-operative optimization of anaemia in elective surgical patients at the Countess of Chester Hospital." International Journal of Surgery 23 (November 2015): S25. http://dx.doi.org/10.1016/j.ijsu.2015.07.072.

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Dobson, Philip F., and Michael R. Reed. "Prevention of infection in primary THA and TKA." EFORT Open Reviews 5, no. 10 (October 2020): 604–13. http://dx.doi.org/10.1302/2058-5241.5.200004.

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Rates of peri-prosthetic joint infection (PJI) in primary total hip and total knee arthroplasty range between 0.3% and 1.9%, and up to 10% in revision cases. Significant morbidity is associated with this devastating complication, the economic burden on our healthcare system is considerable, and the personal cost to the affected patient is immeasurable. The risk of surgical site infection (SSI) and PJI is related to surgical factors and patient factors such as age, body mass index (BMI), co-morbidities, and lifestyle. Reducing the risk of SSI in primary hip and knee arthroplasty requires a multi-faceted strategy including pre-operative patient bacterial decolonization, screening and avoidance of anaemia, peri-operative patient warming, skin antisepsis, povidone-iodine wound lavage, and anti-bacterial coated sutures. This article also considers newer concepts such as the influence of bearing surfaces on infection risk, as well as current controversies such as the potential effects of blood transfusion, laminar flow, and protective hoods and suits, on infection risk. Cite this article: EFORT Open Rev 2020;5:604-613. DOI: 10.1302/2058-5241.5.200004

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Kielty, Jennifer, David Hannon, Andrew Smith, Aine McCarthy, Gloria Avalos, Brendan Dineen, and Jennifer McElwain. "The prevalence of pre-operative anaemia and an examination of its effect on transfusion practice between sexes: A multicentre retrospective study." Transfusion and Apheresis Science 60, no. 3 (June 2021): 103101. http://dx.doi.org/10.1016/j.transci.2021.103101.

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Lichtenegger, P., J. Baron‐Stefaniak, and D. M. Baron. "Pre‐operative anaemia and postoperative acute kidney injury in liver transplantation: valuable but there are still some unanswered questions. A reply." Anaesthesia 75, no. 5 (April 12, 2020): 691. http://dx.doi.org/10.1111/anae.15003.

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Robson, A., J. Sturman, P. Williamson, P. Conboy, S. Penney, and H. Wood. "Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines." Journal of Laryngology & Otology 130, S2 (May 2016): S13—S22. http://dx.doi.org/10.1017/s0022215116000372.

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AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer.Recommendations• Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. (R)• Patients with hypertension of over 180/110 or associated target organ damage, should have antihypertensive medication started pre-operatively as per British Hypertension Society guidelines. (R)• Rapidly correcting pre-operative hypertension with beta blockade appears to cause higher mortality due to stroke and hypotension and should not be used. (R)• Patients with poorly controlled or unstable ischaemic heart disease should be referred for cardiology assessment pre-operatively. (G)• Patients within one year of drug eluting stents should be discussed with the cardiologist who was responsible for their percutaneous coronary intervention pre-operatively with regard to cessation of antiplatelet medication due to risk of stent thrombosis. (G)• Patients with multiple recent stents should be managed in a centre with access to interventional cardiology. (G)• Surgery after myocardial infarction should be delayed if possible to reduce mortality risk. (R)• Patients with critical aortic stenosis (AS) should be considered for pre-operative intervention. (G)• Clopidogrel should be discontinued 7 days pre-operatively; warfarin should be discontinued 5 days pre-operatively. (R)• Patients with thromboembolic disease or artificial heart valves require heparin therapy to bridge peri-operative warfarin cessation, this should start 2 days after last warfarin dose. (R)• Cardiac drugs other than angotensin-converting enzyme inhibitors and angiotensin II antagonists should be continued including on the day of surgery. (R)• Angotensin-converting enzyme inhibitors and angiotensin II antagonists should be withheld on the day of surgery unless they are for the treatment of heart failure. (R)• Post-operative care in a critical care area should be considered for patients with heart failure or significant diastolic dysfunction. (R)• Patients with respiratory disease should have their peri-operative respiratory failure risk assessed and critical care booked accordingly. (G)• Patients with severe lung disease should be assessed for right heart disease pre-operatively. (G)• Patients with pulmonary hypertension and right heart failure will be at extraordinarily high risk and should have the need for surgery re-evaluated. (G)• Perioperative glucose readings should be kept within 4–12 mmol/l. (R)• Patients with a high HbA1C facing urgent surgery should have their diabetes management assessed by a diabetes specialist. (G)• Insulin-dependent diabetic patients must not omit insulin for more than one missed meal and will therefore require an insulin replacement regime. (R)• Patients taking more than 5 mg of prednisolone daily should have steroid replacement in the peri-operative period. (R)• Consider proton pump therapy for patients taking steroids in the peri-operative phase if they fit higher risk criteria. (R)• Surgery within three months of stroke carries high risk of further stroke and should be delayed if possible. (R)• Patients with rheumatoid arthritis should have flexion/extension views assessed by a senior radiologist pre-operatively. (R)• Patients at risk of post-operative cognitive dysfunction and delirium should be highlighted at pre-operative assessment. (G)• Patients with Parkinson's disease (PD) must have enteral access so drugs can be given intra-operatively. Liaison with a specialist in PD is essential. (R)• Intravenous iron should be considered for anaemia in the urgent head and neck cancer patient. (G)• Preoperative blood transfusion should be avoided where possible. (R)• Where pre-operative transfusion is essential it should be completed 24–48 hours pre-operatively. (R)• An accurate alcohol intake assessment should be completed for all patients. (G)• Patients considered to have a high level of alcohol dependency should be considered for active in-patient withdrawal at least 48 hours pre-operatively in liaison with relevant specialists. (R)• Parenteral B vitamins should be given routinely on admission to alcohol-dependent patients. (R)• Smoking cessation, commenced preferably six weeks before surgery, decreases the incidence of post-operative complications. (R)• Antibiotics are necessary for clean-contaminated head and neck surgery, but unnecessary for clean surgery. (R)• Antibiotics should be administered up to 60 minutes before skin incision, as close to the time of incision as possible. (R)• Antibiotic regimes longer than 24 hours have no additional benefit in clean-contaminated head and neck surgery. (R)• Repeat intra-operative antibiotic dosing should be considered for longer surgeries or where there is major blood loss. (R)• Local antibiotic policies should be developed and adhered to due to local resistance patterns. (G)• Individual assessment for venous thromboembolism (VTE) risk and bleeding risk should occur on admission and be reassessed throughout the patients' stay. (G)• Mechanical prophylaxis for VTE is recommended for all patients with one or more risk factors for VTE. (R)• Patients with additional risk factors of VTE and low bleeding risk should have low molecular weight heparin at prophylactic dose or unfractionated heparin if they have severe renal impairment. (R)

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Butt, Binyamin, Mahwish Saif, Sadia Mustafa, and Maryam Khalid. "An Audit of Indications, Complications, Correlation of Preoperative Diagnosis with the Histopathology Report of Hysterectomies at Shalamar Hospital Lahore." Pakistan Journal of Medical and Health Sciences 16, no. 11 (November 30, 2022): 350–52. http://dx.doi.org/10.53350/pjmhs20221611350.

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Introduction: Hysterectomy is the most common gynecological procedure. Abdominal approach is preferred for an enlarged uterus especially in cases of fibroids. However, in a small sized uterus, use of vaginal route is supported in well selected cases Objective: Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with the histopathology report for all hysterectomies, performed in a Shalamar Hospital Lahore. Methods: This study was crass sectional and population the obs. And Gyn. Patients of Shalamar Hospital Lahore. This study is a three year retrospective review of 755 cases of hysterectomy either for gynecological or obstetric reasons managed at Shalamar Hospital Lahore from January 2019 to December 2021. Results: Abdominal hysterectomy accounted for 94%, while vaginal hysterectomy accounted for the remaining 6%. In the former category, an 86% had total abdominal hysterectomy while 9% had subtotal hysterectomy. The average duration of hospital stay following surgery was 3-5 days. The average indoor stay was 2-3 days after vaginal hysterectomy and 4-5days after abdominal hysterectomy. There were 4 cases of mortality accounting for a mortality rate of 1.8 %. Post operative morbidity was encountered in 29.4% of the patients. Anaemia was observed in 45.9%,post operative wound infection in 30.1%, pyrexia in 9% patients, chest infection in 6.7%, bladder injury in 3.6%, bowel injury in 1.8% of the patients. Practical Implication: The practical implication of this study is to correctly treat the patients with pre-operative investigation, Complications, and Correlation of Preoperative Diagnosis with the Histopathology Report of Hysterectomies in private hospitals. Conclusions: Hysterectomy is a major gynaecological procedure. Selection of a appropriate route is very important for the safety of the patient and for hospital stay. Like any other surgery, hysterectomy has an inherent set of complications. So clinical selection should be well justified. Like in any major gynecological procedure, a skilled operator can reduce the morbidity and mortality rates. The conservative approaches should be offered before opting for hysterectomy. Keywords: Pre-operative investigation, Hysterectomies, complications, private hospital, Obs and Gyn patients

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Al Hasani, Khamis M., Abdulaziz A. Bakathir, Ahmed K. Al-Hashmi, Badar Al Rawahi, and Abdullah Albakri. "Modified Le Fort I Osteotomy and Genioplasty for Management of Severe Dentofacial Deformity in β-Thalassaemia Major: Case report and review of the literature." Sultan Qaboos University Medical Journal [SQUMJ] 20, no. 3 (October 5, 2020): 362. http://dx.doi.org/10.18295/squmj.2020.20.03.018.

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β-thalassaemia major is an autosomal recessive form of haemoglobinopathy that is characterised by complete lack of production of the β-chains resulting in multiple complications that include severe anaemia, failure to thrive and skeletal abnormalities. Facial deformities induced by β-thalassaemia major are rare and are very challenging to treat from a surgical point of view. We report a 33-year-old female patient with β-thalassaemia major who presented to the Dental & Maxillofacial Surgery Department, Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with gross dentofacial skeletal deformity contributing to her psychosocial issues. The facial deformity was corrected surgically by excision of the enlarged maxilla, modified Le Fort I osteotomy and advancement genioplasty. This case highlights the pre-operative preparation, surgical management, encountered complications and treatment outcome within 24 months of follow-up.Keywords: Beta-Thalassaemia; Thalassaemia Major; Cooley's Anemia; Le Fort Osteotomy; Genioplasty; Dentofacial Deformities; Case Report; Oman.

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Smith, Louise, Lucy Stead, Russell D. Keenan, and Rekha Thangavelu. "Minimising Transfusion Therapy and Alloimmunisation in Patients with Sickle Cell Disorder in the Era of Hydroxyurea." Blood 132, Supplement 1 (November 29, 2018): 5078. http://dx.doi.org/10.1182/blood-2018-99-119837.

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Abstract In the UK, 700 patients with sickle cell disease are on a transfusion programme1. Red blood cell (RBC) AI occurs in 4.4-76%2 of regularly transfused sickle patients. Contributing factors include repeated transfusions and ethnic differences between sickle cell patients and their donors. This results in higher rates of mismatch in phenotyped and genotyped blood. There is a continued lack of availability of blood products from more compatible ethnic donors. Sickle patients on transfusion programmes are transfused every 3-6 weeks, creating a large burden on healthcare services in terms of time, labour and resources such as extended red cell typing in order to reduce antibody formation. The presence of RBC antibodies in patients can cause significant delays in obtaining cross matched blood and reductions in phenotype matched blood being transfused. The aims of this project were to a) review transfusion use in relation to the use of hydroxyurea (HU) patients treated at Alder Hey (AH) and b) review rates of AI in these patients. At AH we have changed our practice to offer HU from age 9 months as a disease modifying therapy 20-35mg/kg/day. We retrospectively reviewed the use of blood products in our cohort of 60 patients, age between 0-20 years (mean 11yrs). Patients were observed over their life period treated at AH, mean 10.1 patient years, range 0-20years, total of 439 patient years. We studied retrospectively the number of RBC transfusions and the historical presence of antibodies. We then re-tested all patients to determine current antibody status. Prior to commencement of hydroxyurea, 342 units of bloods were transfused to 21 patients over 243 patient years, which is 1.41 units per patient per year. After commencement of hydroxyurea, 114.5 units were transfused to 17 patients in 187.1 patient years, 0.61 units per patient per year. Indications for transfusion included acute chest syndrome, aplastic crisis, prolonged crisis, increased acute anaemia, hydroxyurea induced anaemia, pre-operatively. 3 patients in our cohort had previous antibodies. Upon repeat antibody screening, no patients had detectable RBC antibodies. All patients have an extended red cell phenotype as part of their initial workup on referral to our service. Elective, non-acute patients (transfusion programme, pre-operative, hydroxycarbamide induced anaemia) all receive fully phenotyped blood. This cannot be guaranteed in acute situations where patients receive the best matched blood available. This practice of minimising blood transfusion use in patients with sickle cell anaemia can reduce blood product usage and as a result reduce the demand for ethnic minority transfusion donors. The subsequent donor exposure would therefore also decrease transfusion related complication of AI. 1 National Haemoglobinopathy Registry Annual Report 2016/17 2G. da Cunha Gomes, E & A. F. Machado, L & C. de Oliveira, L & F. N. Neto, J. (2018). The erythrocyte alloimmunisation in patients with sickle cell anaemia: a systematic review: Erythrocyte alloimmunisation in sickle cell anaemia. Transfusion Medicine. 10.1111/tme.12543. Disclosures No relevant conflicts of interest to declare.

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Hung, M., M. Besser, L. D. Sharples, S. K. Nair, and A. A. Klein. "The prevalence and association with transfusion, intensive care unit stay and mortality of pre-operative anaemia in a cohort of cardiac surgery patients*." Anaesthesia 66, no. 9 (July 25, 2011): 812–18. http://dx.doi.org/10.1111/j.1365-2044.2011.06819.x.

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Walker, Victoria, Roslyn Wallace, Arfon Powell, and Joanne Edwards. "P85. Pre-operative anaemia in patients with breast cancer is associated with lymph node metastasis and the systemic inflammatory response but not survival." European Journal of Surgical Oncology (EJSO) 38, no. 11 (November 2012): 1129. http://dx.doi.org/10.1016/j.ejso.2012.07.206.

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Bennett, David, Antonella Fossi, Nicola Lanzarone, Elda De Vita, Luca Luzzi, Piero Paladini, Elena Bargagli, Paola Rottoli, and Piersante Sestini. "Lung transplant in patients with familial pulmonary fibrosis." Jornal Brasileiro de Pneumologia 46, no. 6 (July 27, 2020): e20200032-e20200032. http://dx.doi.org/10.36416/1806-3756/e20200032.

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Objective: Familial pulmonary fibrosis (FPF) is defined as an idiopathic interstitial lung disease affecting two or more members of the same family; poor outcome with high risk of death and chronic lung allograft dysfunction (CLAD) after lung transplant has been reported in these patients. The present study aimed to compare the short- and long term outcome of lung transplants in patients with FPF and patients transplanted because of other interstitial lung diseases. Method: Clinical pre- and post-transplant data from 83 consecutive patients with pulmonary fibrosis who underwent lung transplant at our centre were collected retrospectively. Patients were divided into those with familial (n=9 FPF group) and those with non-familial pulmonary fibrosis (n=74 controls). Results: The FPF group was composed of 4 females and 5 males; 44.5% were ex-smokers. The majority presented their CT scan and pathology evidence of usual interstitial pneumonia. Patients with FPF had significantly lower pre-transplant levels of haemoglobin and haematocrit. No other differences in pre- and post-transplant characteristics were observed concerning controls. The clinical post-operative course was similar in the two groups. No significant difference in one-year CLAD-free survival and overall survival was observed. Conclusion: The post-transplant course of patients with FPF was similar to patients with non-familial pulmonary fibrosis, although more patients with FPF had pre-transplant anaemia. Short- and long-term outcome was comparable in both groups. Lung transplant proved to be a valid option for patients with FPF as it was for patients with other types of pulmonary fibrosis.

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Akhter, Farkhunda, Maliha Khawar, Tooba Hamid, and Moazzam Ali. "SURGICAL SITE INFECTIONS (SSI)." Professional Medical Journal 23, no. 11 (November 10, 2016): 1328–33. http://dx.doi.org/10.29309/tpmj/2016.23.11.1756.

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Objectives: The objective of this study is to determine the frequency ofpost-caesarean SSI and determine the frequency of factors leading to post-caesarean SSI.Study design: Descriptive case series. Setting and duration: Department of Obstetrics &Gynaecology, District Headquarters Teaching hospital, Rawalpindi from June 2015 to Nov2015. Materials and methods: Through non-probability consecutive sampling, 180 patientswho have undergone caesarean section who fulfilled the inclusion criteria were enrolled in thestudy. The data was collected manually on a formatted proforma. All patients suspected ofhaving SSI within 30 days of CS were identified for any pre-operative factors leading to theirSSI. Suspected SSI was confirmed by Culture testing of wound swabs, prior to commencementof an antibiotic treatment or as soon as the diagnosis was suspected. Data was analyzed usingSPSS version 20. Results: Of the 180 patients, 8 suffered from SSI (4.4%). The average agefor the patients was 25.42±3.68 years. The operations were elective in 38.9% of the cases and61.1% were urgent. On data analysis, Diabetes, Anaemia and emergency CS were significantlyassociated with SSI with a p-value less than 0.05. Conclusion: SSI continues to be a significantpost-operative complication. A thorough assessment of risk factors that predispose to SSI andtheir prevention may help in reduction of SSI rates. We recommend that above mentionedfactors to be taken into consideration before planning obstetrical surgeries. Prevention of theseinfections should be a clinical and public health priority.

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Scrimshire, Ashley B., Caroline Fairhurst, Catriona McDaid, and David J. Torgerson. "Effectiveness of pre-operative anaemia screening and increased Tranexamic acid dose on outcomes following unilateral primary, elective total hip or knee replacement: a statistical analysis plan for an interrupted time series and regression discontinuity study." F1000Research 9 (April 1, 2020): 224. http://dx.doi.org/10.12688/f1000research.22962.1.

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Perioperative blood transfusion is associated with poorer postoperative outcomes following hip and knee replacement surgery. Evidence for the effectiveness of some measures aimed at reducing blood transfusions in this setting are limited and often rely on weak pre-post study designs. Quasi-experimental study designs such as interrupted time series (ITS) and regression discontinuity design (RDD) address many of the weaknesses of the pre-post study design. In addition, a priori publication of statistical analysis plans for such studies increases their transparency and likely validity, as readers are able to distinguish between pre-planned and exploratory analyses. As such, this article, written prospective of any analysis, provides the statistical analysis plan for an ITS and RDD study based on a data set of 20,772 primary elective hip and knee replacement patients in a single English NHS Trust. The primary aim is to evaluate the impact of a preoperative anaemia optimisation service on perioperative blood transfusion (within 7 days of surgery) using both ITS and RDD methods. A secondary aim is to evaluate the impact of a policy of increased tranexamic acid dose given at the time of surgery, using ITS methods.

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Journal articles on the topic 'Pre-operative anaemia'

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