By: 20 May 2013

A paper published online in the Canadian Journal of Anesthesia says that hospitals that treat patients with anaemia have better outcomes, including fewer blood transfusions and infections and shorter hospital stays.

A common option for management of anaemia has been blood transfusion, but blood transfusions are expensive and are associated with higher death and complication rates.

Dr Gregory Hare, an anaesthetist at St. Michael’s Hospital, reported that hip and knee replacement patients who had blood transfusions stayed in hospital about two days longer than those who did not have transfusions. The stay was about three days longer for coronary artery bypass graft patients who had transfusions. The risk of infection more than doubled for patients who had transfusions.

Dr Hare called anaemia a “silent killer”. Severe anaemia can cause low oxygen levels in vital organs and may result in heart attacks, strokes and kidney failure. He said early diagnosis of anaemia is important to give doctors sufficient time to treat it before surgery.

For example, 10.4 percent of knee replacement patients diagnosed with anaemia less than seven days before surgery required transfusions, compared to 7.3 percent diagnosed more than 21 days in advance. He said 41.3 percent of patients undergoing coronary artery bypass grafts needed blood transfusions if diagnosed with anaemia less than seven days before surgery, compared with 22.8 percent diagnosed more than 21 days in advance.

“If given time to treat anaemia, we can avoid unnecessary transfusions and thereby improve quality of patient care,” Dr. Hare said.

St. Michael’s is developing a Centre of Excellence for Patient Blood Management, which would be one of the first of its kind in Canada, and a global leader in patient care and in training, research and education for healthcare professionals.

Under patient blood management, physicians might prescribe certain drugs or dietary supplements to raise a patient’s haemoglobin level before surgery.

During surgery, doctors may use a variety of state of-the-art technologies and techniques to minimise blood loss, such as minimally invasive surgery, electrocautery, an argon beam coagulator, or intravenous iron and erythropoietin, which stimulate bone marrow to produce red blood cells.

ONTraC figures published, show the number of patients requiring blood transfusions after undergoing knee surgery fell from 24.5 percent in 2002 to 10.1 percent in 2011. The number requiring transfusions after undergoing coronary artery bypass grafting fell from 60.2 percent to 25.2 percent in the same time.