Search

The purpose of this article is to review the relevant evidence regarding the clinical impact of preoperative anemia, current methods of identifying anemia in the surgical population, and the current and upcoming evidence for the treatment modalities targeting preoperative anemia. Preoperative anemia continues to be identified as a contributor to poor outcomes in the surgical population. Identifying anemia typically starts with hemoglobin and mean corpuscular volume. Recent laboratories have also started using iron studies with serum ferritin and transferrin saturation. Oral and IV iron have demonstrated efficacy in treating preoperative anemia in terms of increasing hemoglobin preoperatively and reducing allogeneic blood transfusions. However, few studies have demonstrated an impact on patient outcomes, morbidity, and mortality. Additionally, several meta-analyses have demonstrated the benefit of adding erythropoietin-stimulating agents to improve anemia. Preoperative anemia is very common and is thought to be a contributor to poor outcomes. IV iron is currently recommended by several guidelines as the primary treatment modality for preoperative anemia. Two ongoing studies hope to provide clarity on the effect of IV iron on patient outcomes including morbidity and mortality in cardiac and non-cardiac surgical populations.

Reducing the Need for HLA-Matched Platelet Transfusion Some patients with acute leukemia or myelodysplastic syndromes with thrombocytopenia may become resistant to random donor transfusions of plat...

Background Among the variables that influence medical decisions, laboratory tests are considered to be among the most important and frequently used. The influence of laboratory tests on medical decisions has been difficult to estimate. The goal of this study was to estimate the number of patient encounters that included a laboratory test. Methods We extracted information for 72196 patient encounters from 1-week intervals each quarter of a year from our comprehensive academic medical center electronic medical record. The patients examined represent a comprehensive range of clinical conditions and medical services. We determined for which encounters laboratory and other orders existed. Results Overall 35% of encounters had 1 or more laboratory tests ordered. However, the percent varied markedly with patient care areas. For inpatient, emergency department, and outpatient populations, 98%, 56%, and 29%, respectively, had 1 or more laboratory tests ordered. Conclusions Our observations support that it is not possible to use a single number to categorize the frequency with which laboratory tests occur in patient encounters. Utilization of laboratory tests varied with type of medical service with almost all inpatients, approximately half of emergency department patients, and nearly one-third of outpatients having laboratory tests during their healthcare visit.