Anaemia and haemostasis overview

Anaemia identification and management and haemostasis management are key components of patient blood management and will enable improved patient outcomes.

 

Anaemia management

Anaemia is common and increases with age. It is independently associated with increased risk of morbidity and mortality and transfusion, which has it's own risks

Preoperative anaemia is particularly common, ranging from 30 – 75% in patients scheduled for elective surgery.(1) For any patient presenting for surgery that may result in significant blood loss, it is important to assess baseline haemoglobin and iron status, and risk of bleeding.(2)

Iron deficiency is the most common cause of anaemia, generally accounting for approximately one-third of cases. Iron deficiency should be distinguished from other causes of anaemia because of its associations with underlying conditions that require specific investigation, and because treatment is simple, safe and effective.(3)

 

Haemostasis management

An assessment of the risk of bleeding may lead to the identification of an unrecognised inherited coagulation defect.(2) Information about congenital and acquired haemostatic defects can be found in our bleeding disorders section.

In perioperative patients, protocols for management of medications including aspirin, NSAIDs, warfarin and the new oral anticoagulant (NOAC) agents should be established. Additionally, the effects of herbal supplements such as garlic, ginseng and ginkgo need to be considered.

Obstetric haemorrhage and massive transfusion require the use of blood products to maintain tissue oxygenation and to reverse or minimise coagulopathy.

 

Patient blood management guidelines

The National Blood Authority Patient Blood Management Guidelines contain recommendations and practice points regarding the identification, evaluation and management of anaemia in all patient groups. For those undergoing planned surgery a Preoperative haemoglobin assessment and optimisation template is available to guide this process. A paediatric haemoglobin assessment and optimisation template is also available for neonates, infants and children.   

The modules contain specific guidance regarding iron and erythrocyte stimulating agent (ESA) therapy, the cessation of mediations that affect haemostasis and techniques and agents that assist to minimise blood loss.

 

References
  1. Shander A, Knight K, Thurer R, Adamson J, Spence R. Prevalence and outcomes of anemia in surgery: a systematic review of the literature. Am J Med 2004;116(Suppl. 7):58–69
  2. Shander A, Waters JH, Gottschall JL. Perioperative Blood Management: A Physician’s Handbook. 2nd edn. AABB; 2009.
  3. Pasricha et al. Diagnosis and management of iron deficiency anaemia: a clinical update. MJA 2010;193:525–532.