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How do we improve outcomes in cardiac surgery patients with preoperative anaemia?
  1. Gavin J Murphy
  1. Correspondence to Professor Gavin Murphy, Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester LE3 9QP, UK; gjm19{at}le.ac.uk

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Introduction

The development of the evidence base to underpin patient blood management, or the safe and effective management of anaemia and severe bleeding, is considered a priority area for research in cardiac surgery. This is because anaemia and severe bleeding are common in this setting, are associated with adverse clinical outcomes and, despite the evaluation of many patient blood management interventions in clinical trials over the last 30 years, few have been shown to be clinically effective in terms of improving prognosis.1

The clinical problem

In cardiac surgery, anaemia is a significant health problem; as many as 30% of patients arrive in the operating theatre with anaemia, and this is associated with up to a twofold increase in the risk of death stroke and acute kidney injury.2 ,3 The relationship between anaemia and outcome is poorly understood, and is probably multifactorial. First, low haemoglobin concentrations may compromise perioperative oxygen delivery leading to tissue hypoxia and organ injury. Second, the preferred treatment of perioperative anaemia is red cell transfusion and this is associated with additional increases in risk beyond those attributable to anaemia alone. Third, preoperative anaemia may be a marker of comorbid conditions that are also risk factors for adverse outcomes.

The knowledge gap

The association between anaemia and adverse outcome is widely accepted and it is sensible to suggest that preoperative assessment and treatment of anaemia should improve outcomes in these patients. This is a level I recommendation in the Society of Thoracic Surgeons (STS) Patient Blood Management Guidelines; however, what preoperative assessment should include …

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