Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines

Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient's target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcome

The influence of allogenic blood transfusion in patients having free-flap primary surgery for oral and oropharyngeal squamous cell carcinoma

The influence of perioperative blood transfusion in oral and oropharyngeal squamous cell carcinoma remains uncertain. It is believed that blood transfusion downregulates the immune system and may have an influence on cancer recurrence and survival. In all, 559 consecutive patients undergoing primary surgery for oral and oropharyngeal squamous cell carcinoma between 1992 and 2002 were included in this study. Known prognostic variables along with transfusion details were obtained from head and neck cancer and blood transfusion service databases, respectively. Adjusting for relevant prognostic factors in Cox regression, the hazard ratio for patients having 3 or more transfused units relative to those not transfused was 1.52 (95% confidence interval (CI) 0.93–2.47) for disease-specific and 1.52 (95% CI 1.05–2.22) for overall mortality. Blood transfusion of 3 or more units might confer a worse prognosis in patients undergoing primary surgery for oral and oropharyngeal squamous cell carcinoma. Therefore, every effort should be made to limit the amount of blood transfused to the minimum requirement

Localization of submicron inclusion re-equilibration at healed fractures in host garnet

Microstructures in Permian inclusion-bearing metapegmatite garnets from the Koralpe (Eastern Alps, Austria) reveal re-equilibration by coarsening of abundant submicron-sized inclusions (1 µm-2 nm diameter) at the site of healed brittle cracks. The microstructures developed during Cretaceous eclogite-facies deformation and the related overprinting of the host-inclusion system. Trails of coarsened inclusions (1-10 µm diameter) crosscut the garnet, defining traces of former fractures with occasional en-echelon overlaps. Trails are flanked by 10- to 100-µmwide 'bleaching zones' characterized by the absence of ≤1-µm-sized inclusions in optical and SE images. FEGmicroprobe data show that trails and bleaching zones can form isochemically, although some trails exhibit non-isochemical coarsening. Cross-correlation-based EBSD analysis reveals garnet lattice rotation of up to 0.45°, spatially correlated with bleaching zones. The garnet lattice in the center of trails is misoriented around different axes with respect to the lattice either side of the trail. Elevated dislocation density within bleaching zones is confirmed by TEM observations. Dislocations represent a plastic wake formed by crystal plastic deformation at the crack tip. Fracture enhanced diffusion rates in the lattice adjacent to crack planes by introducing dislocations, priming these areas to behave differently to the bulk of the garnet during Cretaceous metamorphism and facilitating localized coarsening of inclusions. Diffusion within the bleaching zone was enhanced by a minimum factor of 102. The partially closed host-inclusion system records the influence of deformation mechanisms on re-equilibration and contributes to understanding of the interaction between deformation and chemical reaction during metamorphism. © 2014, Springer-Verlag Berlin Heidelberg

Gutachten zur 'Eignungshoeffigkeit' des Salzstockes Gorleben als Endlager fuer radioaktive Abfaelle. Hydrogeologische und hydraulische Verhaeltnisse im Bereich des Salzstockes Gorleben als Grundlage fuer die Beurteilung der Eignungshoeffigkeit des Standortes fuer die sichere Endlagerung radioaktiver Abfaelle Abschlussbericht

SIGLEAvailable from TIB Hannover: F98B2199 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekNiedersaechsisches Umweltministerium, Hannover (Germany)DEGerman

International consensus statement on the peri-operative management of anaemia and iron deficiency

Despite current recommendations on the management of pre-operative anaemia, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in surgical patients. A number of experienced researchers and clinicians took part in an expert workshop and developed the following consensus statement. After presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the peri-operative period. These statements include: a diagnostic approach for anaemia and iron deficiency in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up. We urge anaesthetists and peri-operative physicians to embrace these recommendations, and hospital administrators to enable implementation of these concepts by allocating adequate resources