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Erschienen in: Wiener Medizinische Wochenschrift 15-16/2014

01.08.2014 | review

Perioperatives Anämiemanagement – Systematischer Review und Meta-Analyse

verfasst von: Dr. Anna Glechner, Prof. Dr. Gerald Gartlehner, MPH, Barbara Nußbaumer, Bakk. BSc, MSc, Prof. Dr. Sibylle Kozek-Langenecker, MBA

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 15-16/2014

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Zusammenfassung

Anämie ist ein Risikofaktor für erhöhte postoperative Morbidität und Mortalität. Internationale Leitlinien empfehlen daher präoperative Diagnostik und kausale Therapie von Anämien. Bei tumorassoziierter Anämie besteht jedoch der Verdacht, dass Eisentherapie zu einer rascheren Progression des Krankheitsverlaufs führen könnte. Ziel unserer systematischen Übersichtsarbeit war die Wirksamkeit und Sicherheit von Interventionen zur Abklärung und kausalen Therapie von perioperativen Anämien zu untersuchen und den Einfluss von Eisenpräparaten auf den Verlauf von Tumorerkrankungen zu erheben.
Wir führten systematische Literatursuchen in mehreren elektronischen Datenbanken durch. Abstracts und Volltexte wurden von zwei Personen unabhängig voneinander beurteilt. Die Einschätzung des Bias-Risikos erfolgte nach Vorgaben der Cochrane Collaboration, die Beurteilung der Qualität der Evidenz nach GRADE (Grading Recommendations Assessment, Development and Evaluation). Meta-Analysen wurden mit zufälligen Effekten nach DerSimonian&Laird berechnet. Ergebnisse zeigten, dass eine präoperative Anämietherapie zur Reduktion von Bluttransfusionen führen kann (relatives Risiko: 0,78, 95 % KI 0,61–1,02; number needed to treat: 6). Für andere patientenrelevante Endpunkte zeigten Ergebnisse aufgrund der geringen Fallzahlen keine klaren Unterschiede. Wir konnten keine Evidenz finden, dass orale Eisengabe den Verlauf von Tumorerkrankungen beeinflusst.
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Literatur
2.
Zurück zum Zitat Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013;30(6):270–382. (PubMed PMID: 23656742).PubMedCrossRef Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013;30(6):270–382. (PubMed PMID: 23656742).PubMedCrossRef
3.
Zurück zum Zitat Goodnough LT, Maniatis A, Earnshaw P, Benoni G, Beris P, Bisbe E, et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth. 2011;106(1):13–22. (PubMed PMID: 21148637. Pubmed Central PMCID: 3000629).PubMedCentralPubMedCrossRef Goodnough LT, Maniatis A, Earnshaw P, Benoni G, Beris P, Bisbe E, et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth. 2011;106(1):13–22. (PubMed PMID: 21148637. Pubmed Central PMCID: 3000629).PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Shander A, Hofmann A, Isbister J, Van Aken H. Patient blood management ult/files. Best Pract Res Clin Anaesthesiol. 2013;27(1):5–10. (PubMed PMID: 23590911).PubMedCrossRef Shander A, Hofmann A, Isbister J, Van Aken H. Patient blood management ult/files. Best Pract Res Clin Anaesthesiol. 2013;27(1):5–10. (PubMed PMID: 23590911).PubMedCrossRef
6.
Zurück zum Zitat Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378(9800):1396–407. (Pubmed Central PMCID: E4).PubMedCrossRef Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378(9800):1396–407. (Pubmed Central PMCID: E4).PubMedCrossRef
7.
Zurück zum Zitat Beguin Y, Aapro M, Ludwig H, Mizzen L, Osterborg A. Epidemiological and nonclinical studies investigating effects of iron in carcinogenesis–a critical review. Crit Rev Oncol Hematol. 2014;89(1):1–15. (Epub 2013/11/28. Eng).PubMedCrossRef Beguin Y, Aapro M, Ludwig H, Mizzen L, Osterborg A. Epidemiological and nonclinical studies investigating effects of iron in carcinogenesis–a critical review. Crit Rev Oncol Hematol. 2014;89(1):1–15. (Epub 2013/11/28. Eng).PubMedCrossRef
8.
Zurück zum Zitat Baker JF, Ghio AJ. Iron homeostasis in rheumatic disease. Rheumatology. 2009;48(11):1339–44. (PubMed PMID: 19628641).PubMedCrossRef Baker JF, Ghio AJ. Iron homeostasis in rheumatic disease. Rheumatology. 2009;48(11):1339–44. (PubMed PMID: 19628641).PubMedCrossRef
9.
Zurück zum Zitat Brabin L, Brabin BJ, Gies S. Influence of iron status on risk of maternal or neonatal infection and on neonatal mortality with an emphasis on developing countries. Nutr Rev. 2013;71(8):528–40. (PubMed PMID: 23865798. Pubmed Central PMCID: 3721428).PubMedCentralPubMedCrossRef Brabin L, Brabin BJ, Gies S. Influence of iron status on risk of maternal or neonatal infection and on neonatal mortality with an emphasis on developing countries. Nutr Rev. 2013;71(8):528–40. (PubMed PMID: 23865798. Pubmed Central PMCID: 3721428).PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat Chapman A, Morgan L, Gartlehner G. Semi-automating the manual literature search for systematic reviews increases efficiency. Health Information & Libraries Journal. 2009;27(1):22–7.CrossRef Chapman A, Morgan L, Gartlehner G. Semi-automating the manual literature search for systematic reviews increases efficiency. Health Information & Libraries Journal. 2009;27(1):22–7.CrossRef
12.
Zurück zum Zitat The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. 2011. The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. 2011.
13.
Zurück zum Zitat Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7(27):iii-x, 1–173.PubMed Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7(27):iii-x, 1–173.PubMed
14.
Zurück zum Zitat Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6. PubMed PMID: 21208779.PubMedCrossRef Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6. PubMed PMID: 21208779.PubMedCrossRef
15.
Zurück zum Zitat World Health Organization. Worldwide prevalence of anaemia 1993–2005. WHO Global Database on Anaemia. 2008. Contract No.: ISBN 978-92-4-159665-7. World Health Organization. Worldwide prevalence of anaemia 1993–2005. WHO Global Database on Anaemia. 2008. Contract No.: ISBN 978-92-4-159665-7.
16.
Zurück zum Zitat Yoo YC, Shim JK, Kim JC, Jo YY, Lee JH, Kwak YL. Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery. Anesthesiology. 2011;115(5):929–37. (PubMed PMID: 22027622. Pubmed Central PMCID: I. Epub 2011/10/27. Eng).PubMedCrossRef Yoo YC, Shim JK, Kim JC, Jo YY, Lee JH, Kwak YL. Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery. Anesthesiology. 2011;115(5):929–37. (PubMed PMID: 22027622. Pubmed Central PMCID: I. Epub 2011/10/27. Eng).PubMedCrossRef
17.
Zurück zum Zitat Lidder PG, Sanders G, Whitehead E, Douie WJ, Mellor N, Lewis SJ, et al. Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery – a prospective, randomised, controlled trial. Annals of the Royal College of Surgeons of England. 2007;89(4):418–21. (Pubmed Central PMCID: I).PubMedCentralPubMedCrossRef Lidder PG, Sanders G, Whitehead E, Douie WJ, Mellor N, Lewis SJ, et al. Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery – a prospective, randomised, controlled trial. Annals of the Royal College of Surgeons of England. 2007;89(4):418–21. (Pubmed Central PMCID: I).PubMedCentralPubMedCrossRef
18.
Zurück zum Zitat Braga M, Gentilini O, Gianotti L, Vignali A, Di Carlo V. Preoperative treatment with recombinant human erythropoietin in anemic patients suffering from digestive tract neoplasms. Chirurgia. 1997;10(6):515–8. Braga M, Gentilini O, Gianotti L, Vignali A, Di Carlo V. Preoperative treatment with recombinant human erythropoietin in anemic patients suffering from digestive tract neoplasms. Chirurgia. 1997;10(6):515–8.
19.
Zurück zum Zitat Devon KM, McLeod RS. Pre and peri-operative erythropoeitin for reducing allogeneic blood transfusions in colorectal cancer surgery. Cochrane Database of Syst Rev. 2009;21(1):CD007148. Devon KM, McLeod RS. Pre and peri-operative erythropoeitin for reducing allogeneic blood transfusions in colorectal cancer surgery. Cochrane Database of Syst Rev. 2009;21(1):CD007148.
20.
Zurück zum Zitat Madi-Jebara SN, Sleilaty GS, Achouh PE, Yazigi AG, Haddad FA, Hayek GM, et al. Postoperative intravenous iron used alone or in combination with low-dose erythropoietin is not effective for correction of anemia after cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18(1):59–63. (PubMed PMID: 14973801. Pubmed Central PMCID: I. Epub 2004/02/20. Eng).PubMedCrossRef Madi-Jebara SN, Sleilaty GS, Achouh PE, Yazigi AG, Haddad FA, Hayek GM, et al. Postoperative intravenous iron used alone or in combination with low-dose erythropoietin is not effective for correction of anemia after cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18(1):59–63. (PubMed PMID: 14973801. Pubmed Central PMCID: I. Epub 2004/02/20. Eng).PubMedCrossRef
21.
Zurück zum Zitat Parker MJ. Iron supplementation for anemia after hip fracture surgery: a randomized trial of 300 patients. J Bone Joint Surg Am. 2010;92(2):265–9. (PubMed PMID: 20124051. Pubmed Central PMCID: I. Epub 2010/02/04. Eng). Parker MJ. Iron supplementation for anemia after hip fracture surgery: a randomized trial of 300 patients. J Bone Joint Surg Am. 2010;92(2):265–9. (PubMed PMID: 20124051. Pubmed Central PMCID: I. Epub 2010/02/04. Eng).
22.
Zurück zum Zitat Prasad N, Rajamani V, Hullin D, Murray JM. Post-operative anaemia in femoral neck fracture patients: does it need treatment? A single blinded prospective randomised controlled trial. Injury. 2009;40(10):1073–6. (PubMed PMID: 19524906. Pubmed Central PMCID: I. Epub 2009/06/16. Eng).PubMedCrossRef Prasad N, Rajamani V, Hullin D, Murray JM. Post-operative anaemia in femoral neck fracture patients: does it need treatment? A single blinded prospective randomised controlled trial. Injury. 2009;40(10):1073–6. (PubMed PMID: 19524906. Pubmed Central PMCID: I. Epub 2009/06/16. Eng).PubMedCrossRef
23.
Zurück zum Zitat Sutton PM, Cresswell T, Livesey JP, Speed K, Bagga T. Treatment of anaemia after joint replacement. A double-blind, randomised, controlled trial of ferrous sulphate versus placebo. J Bone Joint Surg Br. 2004;86(1):31–3. (PubMed PMID: 14765861. Pubmed Central PMCID: I. Epub 2004/02/10. Eng).PubMed Sutton PM, Cresswell T, Livesey JP, Speed K, Bagga T. Treatment of anaemia after joint replacement. A double-blind, randomised, controlled trial of ferrous sulphate versus placebo. J Bone Joint Surg Br. 2004;86(1):31–3. (PubMed PMID: 14765861. Pubmed Central PMCID: I. Epub 2004/02/10. Eng).PubMed
24.
Zurück zum Zitat Anthony LB, Gabrail NY, Ghazal H, Woytowitz DV, Flam MS, Drelichman A, et al. IV iron sucrose for cancer and/or chemotherapy-induced anemia in patients treated with erythropoiesisstimulating agents. Community Oncol. 2011;8(6):270–8. Pubmed Central PMCID: I.CrossRef Anthony LB, Gabrail NY, Ghazal H, Woytowitz DV, Flam MS, Drelichman A, et al. IV iron sucrose for cancer and/or chemotherapy-induced anemia in patients treated with erythropoiesisstimulating agents. Community Oncol. 2011;8(6):270–8. Pubmed Central PMCID: I.CrossRef
25.
Zurück zum Zitat Henry DH, Dahl NV, Auerbach M, Tchekmedyian S, Laufman LR. Intravenous ferric gluconate significantly improves response to epoetin alfa versus oral iron or no iron in anemic patients with cancer receiving chemotherapy. Oncologist. 2007;12(2):231–42. (PubMed PMID: 17296819. Pubmed Central PMCID: I. Epub 2007/02/14. Eng).PubMedCrossRef Henry DH, Dahl NV, Auerbach M, Tchekmedyian S, Laufman LR. Intravenous ferric gluconate significantly improves response to epoetin alfa versus oral iron or no iron in anemic patients with cancer receiving chemotherapy. Oncologist. 2007;12(2):231–42. (PubMed PMID: 17296819. Pubmed Central PMCID: I. Epub 2007/02/14. Eng).PubMedCrossRef
26.
Zurück zum Zitat Pedrazzoli P, Farris A, Del Prete S, Del Gaizo F, Ferrari D, Bianchessi C, et al. Randomized trial of intravenous iron supplementation in patients with chemotherapy-related anemia without iron deficiency treated with darbepoetin alfa. J Clin Oncol. 2008;26(10):1619–25. (Pubmed Central PMCID: I).PubMedCrossRef Pedrazzoli P, Farris A, Del Prete S, Del Gaizo F, Ferrari D, Bianchessi C, et al. Randomized trial of intravenous iron supplementation in patients with chemotherapy-related anemia without iron deficiency treated with darbepoetin alfa. J Clin Oncol. 2008;26(10):1619–25. (Pubmed Central PMCID: I).PubMedCrossRef
27.
Zurück zum Zitat Heiss MM, Tarabichi A, Delanoff C, Allgayer H, Jauch KW, Hernandez-Richter T, et al. Perisurgical erythropoietin application in anemic patients with colorectal cancer: a double-blind randomized study. Surgery. 1996;119(5):523–7. (PubMed PMID: 8619207. Epub 1996/05/01. Eng).PubMedCrossRef Heiss MM, Tarabichi A, Delanoff C, Allgayer H, Jauch KW, Hernandez-Richter T, et al. Perisurgical erythropoietin application in anemic patients with colorectal cancer: a double-blind randomized study. Surgery. 1996;119(5):523–7. (PubMed PMID: 8619207. Epub 1996/05/01. Eng).PubMedCrossRef
28.
Zurück zum Zitat Kettelhack C, Hones C, Messinger D, Schlag PM. Randomized multicentre trial of the influence of recombinant human erythropoietin on intraoperative and postoperative transfusion need in anaemic patients undergoing right hemicolectomy for carcinoma. Br J Surg. 1998;85(1):63–7. (PubMed PMID: 9462386. Epub 1998/02/14. Eng).PubMedCrossRef Kettelhack C, Hones C, Messinger D, Schlag PM. Randomized multicentre trial of the influence of recombinant human erythropoietin on intraoperative and postoperative transfusion need in anaemic patients undergoing right hemicolectomy for carcinoma. Br J Surg. 1998;85(1):63–7. (PubMed PMID: 9462386. Epub 1998/02/14. Eng).PubMedCrossRef
29.
Zurück zum Zitat Qvist N, Boesby S, Wolff B, Hansen CP. Recombinant human erythropoietin and hemoglobin concentration at operation and during the postoperative period: reduced need for blood transfusions in patients undergoing colorectal surgery–prospective double-blind placebo-controlled study. World J Surg. 1999;23(1):30–5. (PubMed PMID: 9841760. Epub 1998/12/05. Eng).PubMedCrossRef Qvist N, Boesby S, Wolff B, Hansen CP. Recombinant human erythropoietin and hemoglobin concentration at operation and during the postoperative period: reduced need for blood transfusions in patients undergoing colorectal surgery–prospective double-blind placebo-controlled study. World J Surg. 1999;23(1):30–5. (PubMed PMID: 9841760. Epub 1998/12/05. Eng).PubMedCrossRef
30.
Zurück zum Zitat Saleh E, McClelland DB, Hay A, Semple D, Walsh TS. Prevalence of anaemia before major joint arthroplasty and the potential impact of preoperative investigation and correction on perioperative blood transfusions. Br J Anaesth. 2007;99(6):801–8. (PubMed PMID: 17959586).PubMedCrossRef Saleh E, McClelland DB, Hay A, Semple D, Walsh TS. Prevalence of anaemia before major joint arthroplasty and the potential impact of preoperative investigation and correction on perioperative blood transfusions. Br J Anaesth. 2007;99(6):801–8. (PubMed PMID: 17959586).PubMedCrossRef
31.
Zurück zum Zitat Ludwig H, Van Belle S, Barrett-Lee P, Birgegard G, Bokemeyer C, Gascon P, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer. 2004;40(15):2293–306. (PubMed PMID: 15454256).PubMedCrossRef Ludwig H, Van Belle S, Barrett-Lee P, Birgegard G, Bokemeyer C, Gascon P, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer. 2004;40(15):2293–306. (PubMed PMID: 15454256).PubMedCrossRef
32.
Zurück zum Zitat Knight K, Wade S, Balducci L. Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):11S–26S. (PubMed PMID: 15050883).PubMedCrossRef Knight K, Wade S, Balducci L. Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):11S–26S. (PubMed PMID: 15050883).PubMedCrossRef
33.
Zurück zum Zitat Gafter-Gvili A, Rozen-Zvi B, Vidal L, Leibovici L, Vansteenkiste J, Gafter U, et al. Intravenous iron supplementation for the treatment of chemotherapy-induced anaemia – systematic review and meta-analysis of randomised controlled trials. Acta Oncol. 2013;52(1):18–29. (PubMed PMID: 22877242).PubMedCrossRef Gafter-Gvili A, Rozen-Zvi B, Vidal L, Leibovici L, Vansteenkiste J, Gafter U, et al. Intravenous iron supplementation for the treatment of chemotherapy-induced anaemia – systematic review and meta-analysis of randomised controlled trials. Acta Oncol. 2013;52(1):18–29. (PubMed PMID: 22877242).PubMedCrossRef
34.
Zurück zum Zitat Goodnough LT. Risks of blood transfusion. Crit Care Med. 2003;31(12 Suppl):S678Sup. (PubMed PMID: 14724466).CrossRef Goodnough LT. Risks of blood transfusion. Crit Care Med. 2003;31(12 Suppl):S678Sup. (PubMed PMID: 14724466).CrossRef
35.
Zurück zum Zitat Shander A, Hofmann A, Ozawa S, Theusinger OM, Gombotz H, Spahn DR. Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion. 2010;50(4):753–65. (PubMed PMID: 20003061. Epub 2009/12/17. Eng).PubMedCrossRef Shander A, Hofmann A, Ozawa S, Theusinger OM, Gombotz H, Spahn DR. Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion. 2010;50(4):753–65. (PubMed PMID: 20003061. Epub 2009/12/17. Eng).PubMedCrossRef
Metadaten
Titel
Perioperatives Anämiemanagement – Systematischer Review und Meta-Analyse
verfasst von
Dr. Anna Glechner
Prof. Dr. Gerald Gartlehner, MPH
Barbara Nußbaumer, Bakk. BSc, MSc
Prof. Dr. Sibylle Kozek-Langenecker, MBA
Publikationsdatum
01.08.2014
Verlag
Springer Vienna
Erschienen in
Wiener Medizinische Wochenschrift / Ausgabe 15-16/2014
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI
https://doi.org/10.1007/s10354-014-0293-x

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