Preoperative anemia management in the coronavirus disease (COVID-19) era
| Autor: | Victor A. Ferraris, Seth I. Perelman, Aryeh Shander, Christian Mabry |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
allogeneic
medicine.medical_specialty business.industry cardiac Psychological intervention Conflict of interest COVID-19 Perioperative preoperative anemia Risk factor (computing) Expert Opinion Triage Pandemic Medicine Observational study business Risk assessment Intensive care medicine RBC transfusion |
| Zdroj: | Jtcvs Open |
| ISSN: | 2666-2736 |
| Popis: | While the focus of this review is on preoperative anemia management, a modifiable risk factor and the cornerstone of PBM, the importance of other allogeneic components on adverse outcomes and the impact of the pandemic on their availability, especially platelets with their short shelf life, should not be minimized. The implementation of a multidisciplinary PBM program with an emphasis on meticulous surgical and perioperative hemostasis will contribute to decreased allogeneic component utilization with improved patient outcomes. Cardiac surgery PBM initiatives should include the identification of patients at high risk of bleeding, minimizing intraoperative hemodilution, maintaining normothermia, prevention of fibrinolysis, individual heparin/protamine titration, use of cell salvage, and perioperative treatment algorithms for bleeding patients.57 The COVID-19 epidemic created a dramatic shift in patient triage and in the use of surgical resources. The epidemic-related changes to blood supply, and transfusion needs offers multiple opportunities and challenges for transfusion decisions and for management of blood resources. Limited early experience suggests several features associated with blood resource management during the pandemic. Delays in timing of operations offers an ideal opportunity to improve coagulation parameters and optimize RBC levels. Improving preoperative patient profiles includes a multifaceted approach to risk assessment and careful triage. A preoperative anemia clinic can help in this process. The uncertain duration of this pandemic, and the likelihood of future pandemics, makes it necessary to implement pandemic-specific interventions that may not have robust evidence but are supported by short-term experience and observational data. These alternatives offer the best options for management until a larger more robust evidence base is accrued. Conflict of Interest Statement Dr Shander has received funding from Masimo, CSL Behring, Pharmacosmos, and Daiichi-Sankyo, which are unrelated to the submitted work but may contain relevant conflicts of interest. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. |
| Databáze: | OpenAIRE |
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