naa a22 4500 510744419 CHVBK 20180411083040.0 cr unu---uuuuu 180411e20130201xx s 000 0 eng 10.1007/s12630-012-9861-y doi (NATIONALLICENCE)springer-10.1007/s12630-012-9861-y Review article: Risks of anemia and related management strategies: can perioperative blood management improve patient safety? [Elektronische Daten] [Gregory Hare, John Freedman, C. David Mazer] Article de synthèse: Risques d'anémie et stratégies de prise en charge: la gestion périopératoire du sang peut-elle améliorer la sécurité du patient? Purpose: Anemia in both acute and chronic conditions is associated with an increased risk of organ injury (brain, heart, kidney) and mortality. Thus, anemia is not "safe”. Impairment of tissue oxygen delivery likely contributes as a central mechanism; however, the existing treatments for anemia (i.e., transfusion, erythropoiesis stimulating agents, blood substitutes) have not produced a demonstrable improvement in patient outcomes despite their efficacy to increase blood oxygen content. Indeed, transfusion of red blood cells (RBCs) has been attributed to increase mortality in non-bleeding patients. Thus, the pathophysiology of anemia-induced morbidity and mortality and its treatments are complex and incompletely understood. New knowledge continues to emerge regarding the cellular mechanisms that maintain oxygen homeostasis during anemia. Nevertheless, the application of this knowledge has not yet led to improvements in patient outcomes. As both anemia and transfusion are associated with increased mortality, utilization of multimodal patient blood management strategies may be effective in avoiding both of these predictors of adverse outcomes. We propose to review new strategies to avoid both anemia and transfusion with the goal of improving patient outcomes and safety. Principal findings: We reviewed several approaches that utilize patient blood management to improve patient outcomes, including 1) characterization of biomarkers of anemia-induced tissue hypoxia to identify appropriate patient-specific treatment thresholds or hemoglobin (Hb) triggers; 2) development of adequately powered clinical trials that will help to define appropriate guidelines for the perioperative treatment of anemia and optimal Hb thresholds for transfusion of RBCs in specific patient populations; and 3) demonstration that an established blood conservation program (ONTraC) can reduce RBC transfusion and its associated adverse outcomes. Conclusions: Anemia is associated with increased morbidity and mortality. Ongoing initiatives to treat anemia and optimize patient blood management may improve patient outcomes. A broader application of these approaches may improve the overall safety of anesthesia and surgery for patients with anemia. Canadian Anesthesiologists' Society, 2013 Hare Gregory Department of Anesthesia, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada aut Freedman John Division of Hematology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada aut David Mazer C. Department of Anesthesia, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/2(2013-02-01), 168-175 0832-610X 60:2<168 2013 60 12630 https://doi.org/10.1007/s12630-012-9861-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-012-9861-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hare Gregory Department of Anesthesia, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Freedman John Division of Hematology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- David Mazer C. Department of Anesthesia, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/2(2013-02-01), 168-175 0832-610X 60:2<168 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer