Manejo de la anemia ferropénica por la enfermera de preanestesia respecto a las tasas de transfusión perioperatoria / Management of iron deficiency anaemia by the preanaesthesia nurse with respect to perioperative transfusion rates

Objetivo: Describir la prevalencia de transfusión sanguínea (TS) perioperatoria en pacientes con anemia ferropénica preoperatoria y sometidos a cirugía mayor electiva, incluidos en un protocolo de hierro intravenoso (FE IV) liderado por la enfermera de preanestesia. Método: Estudio descriptivo, observacional, longitudinal y retrospectivo en una población de pacientes sometidos a cirugía mayor electiva, vistos en consulta de enfermería de anestesia en un hospital de tercer nivel entre abril de 2014 y enero de 2017. Se incluyeron en el estudio aquellos pacientes con anemia ferropénica incluidos en un protocolo de tratamiento con FE IV prequirúrgico. Resultados: Se estudiaron 50 pacientes. El 12% precisó una TS. Se observó una asociación estadísticamente significativa entre la necesidad de TS intraoperatoria y el número de días entre la primera administración de FE IV y la fecha de la cirugía (p < 0,01), y también con el número de días entre la última administración de FE IV y la intervención quirúrgica (p = 0,04). El aumento de la hemoglobina fue mayor en los pacientes que recibieron más de una dosis frente a los que solo recibieron una dosis de 1.000 mg (p < 0,01). Conclusiones: En nuestro estudio hemos estimado un aumento de la hemoglobina mayor que en otros estudios y una tasa de administración de TS baja (12%). El papel de la enfermera es fundamental para la preselección de estos pacientes

Objective: To describe the prevalence of perioperative blood transfusion (BT) for patients with preoperative iron deficiency anaemia and undergoing major elective surgery, included in an intravenous iron protocol (IV Fe) led by the pre-anaesthesia nurse. Method: Observational, descriptive, longitudinal and retrospective study in a population of patients undergoing major elective surgery, seen in anaesthesia nursing consultation in a tertiary hospital between April 2014 and January 2017. The patients with iron deficiency anaemia, included in the study, were included in a protocol of treatment with preoperative IV Fe. Results: Fifty patients were studied. Twelve percent required a BT. A statistically significant association was observed between the need for intraoperative BT and the number of days between the first administration of IV Fe and date of surgery (P < .01) and also the number of days between the last administration of IV Fe and the surgical intervention (P = .04). The increase in haemoglobin was greater in patients who received more than one dose compared to those who received only one dose of 1,000 mg (P < .01). Conclusions: In our study, we estimated an increase in haemoglobin greater than in other studies and a low administration rate of BT (12%). The role of the nurse is fundamental for the preselection of these patients

Iron deficiency anemia in pregnant women.

Screening for iron deficiency anemia (IDA) in all pregnant women is recommended. IDA is a prevalent cause of nutritional deficiency anemia, and oral iron is the first line of treatment. Other treatments include parenteral iron or blood transfusion(s). Untreated IDA in pregnancy can result in complications for the mother and fetus.

Ferropenia y anemia ferropénica. Tratamiento con hierro intravenoso a altas dosis / Iron deficiency and iron deficiency anemia. High-dose intravenous iron treatment

La anemia por déficit de hierro puede ser habitual en diferentes patologías agudas y crónicas. La vía de primera elección para la reposición de hierro es la oral. Sin embargo, cuando esta vía resulta ineficaz, es mal tolerada o está contraindicada o, cuando hay que tratar una anemia grave o existe la necesidad de recuperación rápida de los niveles de hierro corporal, se recomienda la repleción de hierro por vía endovenosa. El hierro administrado por vía intravenosa permite una rápida y eficiente corrección de los niveles de hierro. Los preparados intravenosos actuales presentan el hierro asociado a moléculas de polisacáridos que facilitan su liberación lenta y controlada, biodisponible para su unión a las proteínas específicas de almacenaje o transportadoras. Gracias a ello, se reduce la toxicidad por hierro libre y se hace posible la administración de altas dosis en intervalos cortos de tiempo. La introducción de preparados que permiten la administración de hierro sin dosis techo, como el hierro isomaltósido, además de reponer eficazmente los niveles de hierro, incide significativamente en la calidad de vida de los pacientes, ya que reduce el número de visitas y desplazamientos a los centros sanitarios, disminuye el número de punciones preservando los accesos venosos, minimiza las interferencias en sus actividades cotidianas y mejora los recursos sanitarios (AU)

Iron deficiency anemia is common in different acute and chronic diseases. The current first line of therapy is oral iron supplementation. However, when this method is ineffective, poorly tolerated, contraindicated, when dealing with severe anemia or facing the need for rapid recovery of iron levels, it is recommended to replete iron intravenously. Administering intravenous iron allows for a fast and efficient correction of iron levels. Current injectable solutions contain iron in combination with polysaccharide molecules which facilitate slow and controlled iron release, making it bioavailable to bind with transport and storage proteins. As a result, toxicity is reduced allowing for high-dose administration in short time intervals. Administering high-dose solutions of intravenous iron, such as iron isomaltoside, apart from effectively replenishing iron levels, significantly improves patients quality of life, reduces the frequency of hospital or clinic visits and decreases punctures preserving the venous access, minimizes interference with daily activities and benefits health care resources (AU)

Significado de la anemia en las diferentes etapas de la vida / Significance of anaemia in the different stages of life

Resumen: La anemia presenta una elevada prevalencia en las consultas de atención primaria y pediatría, y la ADH representa el 50% de todos los casos de anemia. Metodología: Revisión bibliográfica y análisis descriptivo documental sobre etiopatogenia de la anemia ferropénica, las pruebas diagnósticas básicas para el estudio de la ADH y su significado, utilizando una temporalidad determinada en la búsqueda documental y criterios de inclusión atendiendo a las dimensiones que se analizan en el estudio: Nociones acerca del metabolismo del hierro. Nociones acerca de la hematopoyesis. Diagnóstico por el laboratorio y clasificación de las anemias. Clínica de la anemia ferropénica. Causas de la deficiencia de hierro. Resultados y conclusión: EL estudio documental efectuado nos presenta la existencia de publicaciones con contenidos sobre etiopatogenia de la anemia ferropénica, las pruebas diagnósticas básicas para el estudio de la ADH y su significado, evidenciando la importancia de este contenido para el profesional de enfermería en el área de la atención primaria y pediatría (AU)

Overview: Anemia is very common in primary care consultations and pediatrics, and IDA is the cause of 50% of all cases of anemia. Methodology: Literature review and documentary descriptive analysis of the pathogenesis of iron-deficiency anemia, the basic diagnostic tests to study IDA and the significance of such using a specific time period in the documentary search and inclusion criteria that takes into account factors that are analyzed in the study: Ideas about the metabolism of iron. Ideas about hematopoiesis. Laboratory diagnosis and classification of anemia. Clinical features of iron deficiency anemia. Causes of iron deficiency. Results and conclusion: The staged documentary study covers the publications on the pathogenesis of iron deficiency anemia, the basic diagnostic tests to study the IDA and the significance of such, and it shows how important this data is for professional nursing in the area of primary care and pediatrics, to identify it and act accordingly

Evaluación de la administración de carboximaltosa férrica intravenosa en la consulta de enfermedad renal crónica avanzada, para el control de la anemia / Evaluation of the intravenous administration of iron carboxymaltose for controlling anemia in advanced chronic kidney disease

La carboximaltosa férrica es una formulación de hierro endovenosa segura y de fácil dosificación, se puede administrar hasta 1 gramo iv en una sola sesión y permite ahorro de tiempo de los pacientes y de enfermería. Presentamos los resultados de su administración en una consulta de enfermedad renal crónica, analizando sus resultados y la repercusión en la carga de trabajo del personal de enfermería. Material y Métodos: Se analizaron todos los pacientes en seguimiento de la consulta de enfermedad renal crónica en nuestro centro desde Ene-11 hasta Dic-14 que recibieron carboximaltosa férrica iv. Se registraron sus datos basales y los resultados clínicos y analíticos a los seis meses. Resultados: Fueron identificados 85 pacientes en ese periodo. Edad media de 72±12 años, con un filtrado glomerular estimado basal de 28±11ml/min y a los seis meses de 30±11 (p:n.s). La hemoglobina basal y a los seis meses fueron de 10±4 y 11±3 g/dl respectivamente (p:<0,001). El hematocrito basal y final fueron: 34±4 vs 39±6 % (p:<0,001). Los niveles de ferritina e índice de saturación de transferrina basales vs seis meses fueron respectivamente: 88±97 vs 308±327 ng/ml (p:<0,001) y 11,2±6 vs 22,3±11 (p:<0,001). Dado que el tiempo medio de administración de cualquier formulación de hierro endovenoso es de 30 minutos, la estimación en base al número de administraciones es de un ahorro de 85 y 170 horas en estos 4 años si se compara con formulaciones que requieren de tres a cinco sesiones respectivamente. A su vez el número de punciones se ha reducido, sin observarse complicaciones asociadas. Conclusiones: La carboximaltosa férrica es segura y eficaz mostrando una recuperación de los niveles de hemoglobina y de los depósitos de hierro. Su facilidad de administración ha permitido ahorros sustanciales de tiempo. Esto junto a sus escasos efectos secundarios la hacen idónea para la administración ambulatoria (AU)

Ferric carboxymaltose is a safe and easy dosage of intravenous iron formulation; it can be administered intravenously up to 1 gram in a single session and allows time savings of patients and nursing. We present the results of his administration in a unit of chronic kidney disease, analyzing the results and the impact on the workload of the nursing staff. Materials and methods: All patients followed in the chronic kidney disease unit at our center from January 2011 to December 2014 and who received intravenous iron carboxymaltose were analyzed. Their baseline data and clinical and laboratory results at six months were recorded. Results: 85 patients were identified during this period. Mean age of 72 ± 12 years, with a baseline estimated glomerular filtration rate of 28 ± 11 ml / min and at six months of 30 ± 11 (p >0.05). Baseline and at six months hemoglobin levels were 10 ± 4 and 11 ± 3 g / dl, respectively (p <0.001). The basal and final hematocrit were: 34 ± 4 vs 39 ± 6% (p <0.001). Baseline ferritin levels and transferrin saturation index versus levels at six months were respectively: 88 ± 97 vs 308 ± 327 ng / ml (p <0.001) and 11.2 ± 6 vs 11 ± 22.3 (p <0.001 ). Since the average administration time by any formulation of intravenous iron is 30 minutes, the estimate based on the number of administrations is a saving of 85 and 170 hours on these four years when compared with formulations that require three to five respectively sessions. In turn, the number of punctures has been reduced without associated complications observed. Conclusion: Carboxymaltose iron is safe and effective showing a recovery of hemoglobin levels and iron deposits. Its ease of administration has allowed substantial time savings. This, together with its few side effects makes it ideal for outpatient administration (AU)

Anemic Control in Patients with Chronic Kidney Disease: A Controversial Issue.

Anemia in chronic kidney disease doubles the risk of death and leads to many complications. Management includes erythropoietin-stimulating agent therapy, treatment of iron deficiency, patient education, and collaboration with the multidisciplinary team.

Biosimilar ESAs: a comparative review.

BACKGROUND: The management of anaemia in patients with chronic kidney disease has been transformed by development of erythropoiesis-stimulating agents (ESAs). Following expiry of the patent of the originator epoetin alfa in Europe, a number of biosimilar ESAs have been licensed for use in the nephrology setting. Biosimilars are biological medicines that are approved via stringently defined regulatory pathways on the basis that they have demonstrated comparable safety, efficacy and quality to their reference product. OBJECTIVES: As nurses have a pivotal role in patient care, not only administering medications but also educating patients about their treatment options, it is important that nurses understand the differences between biosimilar medicines and their reference products and appreciate the stringent regulatory requirements for approval of biosimilars. METHODS: In this review, we use epoetin zeta as a case study to highlight practical considerations of using biosimilar ESAs in the management of patients with kidney disease. RESULTS AND CONCLUSION: Biosimilar products, such as epoetin zeta, may offer a range of features to patients, nurses and physicians, such as greater flexibility over dose and route of administration, in addition to greater access to biological medicines through cost savings. APPLICATION TO PRACTICE: Renal nurses play a significant role in the management of patients with kidney disease and anaemia, not only having an important role in the delivery of medicine but also in the education of patients. This review discusses some of the practical aspects associated with the use of biosimilar medicines to assist nurses in making informed decisions over their use.

SCIENTIFIC PAPER PRESENTATION DURING CONCURRENT INTEREST SESSION. Community Health Nursing (Speciality). Iron-deficiency anemia.

Iron deficiency anaemia is the most common form of malnutrition in the world. The global prevalence of anaemia mainly in South East Asia is 65.5 percent, in India 56 percent among adolescent girls. A study conducted to assess the effectiveness of structured teaching programme on knowledge and attitude of adolescent girls in prevention of iron and folic acid deficiency anaemia at a selected corporation school. It adopted one group pre-test post-test design with 60 samples selected by employing stratified random sampling technique. The study revealed that during pre-test 90 percent of them had inadequate knowledge and 65 percent of them had unfavourable attitude towards iron and folic acid deficiency anaemia. After the structured teaching programme the knowledge and attitude was improved (73% had adequate knowledge and 79% had most favourable attitude). Overall the structured teaching programme was found effective in improving the knowledge and attitude of adolescent girls in prevention of iron and folic acid deficiency anaemia.

'This is normal during pregnancy': a qualitative study of anaemia-related perceptions and practices among pregnant women in Mumbai, India.

OBJECTIVES: to explore anaemia-related perceptions and practices among pregnant women in Mumbai, India. DESIGN: descriptive qualitative study using in-depth interviews and focus group discussions. SETTING: three government-run maternity hospitals in Mumbai, India. PARTICIPANTS: 31 pregnant women aged 18-33 years; three women completed higher secondary school; 28 were homemakers. FINDINGS: respondents described anaemia as 'lack of blood in the body' because that was the term used by health providers; yet they did not seem worried about the consequence on their own health. Women perceived anaemia as 'normal during pregnancy' because their body had to simply share resources with the fetus and every female relative had suffered from it during pregnancy. Respondents did recognise weakness and dizziness as symptoms of anaemia. They attributed the cause to a poor diet, but did not know the specific link with iron-deficiency. They listed various negative effects of anaemia on the fetus, but very few stated ill-effects on the mother, and none stated maternal death as an outcome. Women saw their role primarily as child-bearers and prioritised newborn's health over their own. CONCLUSION AND IMPLICATIONS: anaemia stands at the intersection of health, nutrition, culture and gender. Interventions in the country have to go beyond distributing or monitoring compliance with iron-folic acid (IFA) supplements. Health education programmes for women and household members have to highlight the seriousness of anaemia and address socio-cultural norms and gendered behaviours in families with respect to nutrition and health. There is an urgent need in maternal and child health programmes to emphasise the importance of the mother's own health. Anaemia interventions have the potential to become proxies for women's health and empowerment programmes.

Iron deficiency anaemia in chronic kidney disease.

BACKGROUND: Iron Deficiency Anaemia (IDA) has been shown to be the most common cause of anaemia worldwide. It is accepted that people with chronic kidney disease (CKD) develop anaemia as their kidney function declines. METHODS: To better understand IDA in CKD, it is necessary to appreciate the normal iron metabolism and utilisation of iron and how these processes can be disordered in patients with CKD. The problems related to infection / inflammation and oxidative stress are examined. Whilst National and international guidelines recommend specific tests for IDA, these and alternative tests are reviewed. CONCLUSIONS: Whilst iron supplementation is necessary for CKD patients with IDA, iron metabolism and utilisation can be affected by factors such as infection or inflammation. Iron is essential element for all life, it can be toxic to cells through the process of oxidative stress. The recommended tests for IDA may be affected by factors such as infection and inflammation. Alternative tests are available, which may be a more accurate indicator of IDA as they are not affected by external factors.

Are C-reactive protein and ferritin levels being overlooked in indigenous australians with chronic kidney disease?

BACKGROUND: Indigenous Australians have significantly higher rates of end-stage renal disease and worse health outcomes than non-indigenous Australians. OBJECTIVES: We investigated whether the effect of inflammation on C-reactive protein (CRP) and ferritin levels is being overlooked in indigenous patients with chronic kidney disease. DESIGN: Data for 23,000 patients were extracted from the Renal Anaemia Management database for the period November 1999 to October 2010. MEASUREMENT: Haemoglobin, ferritin, transferrin saturation and CRP levels for indigenous and non-indigenous Australians were compared with target levels given in the Caring for Australians with Renal Impairment (CARI) guidelines. RESULTS: Compared with non-indigenous patients, indigenous Australians had higher median CRP and mean ferritin levels, lower mean haemoglobin level and were less likely to meet CARI targets. CONCLUSION: The effect of inflammation on laboratory parameters should be considered particularly when treating indigenous Australians.

Anaemia and iron deficiency in cardiac patients: what do nurses and allied professionals know?

BACKGROUND: Cardiac nurses and allied professionals often take care of patients who also have anaemia or iron deficiency. To deliver optimal care, professionals should be knowledgeable about the prevalence, diagnosis, pathophysiology, and therapeutic management of these conditions. We therefore set out a survey to get a first impression on the current knowledge of nurses and allied professionals on anaemia and iron deficiency. METHOD: A questionnaire was designed for this study by the Undertaking Nursing Interventions Throughout Europe (UNITE) Study Group. Data were collected from 125 cardiovascular nurses and allied professionals visiting the 11th Annual Spring Meeting of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology. RESULTS: Most respondents had general knowledge on the definition of anaemia and iron deficiency and 54% of the respondents rated anaemia and iron deficiency as important when evaluating a cardiac patient. Specific knowledge regarding anaemia and more prominently of iron deficiency was not optimal. CONCLUSION: Although cardiac nurses and allied professionals have basic knowledge of anaemia and iron deficiency, they would benefit from additional knowledge and skills to optimally deliver patient care.

Anaemia management in cardio renal disease.

Anaemia is common in congestive heart failure (CHF) and is associated with increased mortality, morbidity and progressive renal failure. The common causes of the anaemia are the associated renal failure and excessive cytokine production, both of which can cause depression of the erythropoietin (EPO) production in the kidney and depression of EPO response in bone marrow. The cytokines can also induce iron deficiency by increasing hepcidin production from the liver, which both reduces gastrointestinal iron absorption and reduces iron release from iron stores located in the macrophages and hepatocytes. Attempts to control this anaemia will have to consider the use of both erythropoiesis stimulating agents (ESA) as well as oral and, probably more importantly, intravenous (IV) iron. Studies of anaemia in CHF with ESA and oral or IV iron and even with IV iron alone have shown a positive effect on hospitalisation, fatigue and shortness of breath, cardiac and renal function, quality-of-life, exercise capacity and reduced beta natriuretic peptide and have not demonstrated an increase in cardiovascular damage related to therapy. Although some studies and meta-analyses have revealed improvement in these parameters others have not. Adequately powered long-term placebo-controlled studies of ESA and of IV iron in CHF are needed and are currently being carried out.

Creative iron management--a practical guide.

The use of intravenous (IV) iron is now part of the every day management of anaemia in people with Chronic Kidney Disease (CKD). The increase in the number of referrals to renal services since the introduction of estimated glomerular filtration rate (eGFR) reporting in 2006 in England means that people with CKD are being identified earlier and consequently, complications such as anaemia are being highlighted sooner. The prevalence of anaemia of CKD has been estimated in a population study of stage 3-5 CKD as 4.5% (John et al. 2004). People with stage 3 CKD and diabetes have a 22% incidence of anaemia that is much greater than the incidence of 7.9% in those without diabetes (El Achkar et al. 2005). The increase in numbers requiring anaemia management is having an impact on resources and service provision, in particular the treatment of iron deficiency with IV iron. A need to be creative and investigate alternative ways of using resources and providing services in different settings was identified by the multiprofessional members of the Anaemia Nurse Specialist Association (ANSA) and the CKD forum (a project group of the British Renal Society). The outcome has been the production of a practical guide for healthcare professionals to assist with the development of IV iron services in a nonacute hospital setting. The guide was launched at the annual ANSA conference (April 2009) and British Renal Society conference (June 2009).

Cuidados de enfermería en niños con anemia ferripriva / Nursery care in children with iron deficiency anemia

La prevención y control de la anemia ferripriva en el ámbito comunitario demanda de una contribución esmerada y especializada del personal de enfermería, con un enfoque integral, valorando no sólo el estado físico del niño sino también el mental, el entorno social y familiar. Se realizó un estudio descriptivo transversal sobre los cuidados de enfermería en niños con anemia ferripriva del consejo popular Jesús Menéndez perteneciente a la Policlínica Universitaria Jimmy Hirtzel del municipio Bayamo, de julio a diciembre del 2007; con el objetivo de describir los cuidados de enfermería recibidos en relación con dicha entidad, por parte de los niños afectados. La muestra estuvo constituida por 17 infantes menores de 3 años. Los diagnósticos de enfermería que predominan en el seguimiento clínico de la anemia ferripriva en niños estuvieron relacionados con la palidez de la piel y las mucosas. El cuidado hacia el consumo diario del tratamiento médico se efectuó en la totalidad de los casos. El mayor porciento de los familiares implicados recibió orientación precisa sobre las fuentes de alimentos ricas en hierro e importancia de una dieta equilibrada, las acciones orientadas al control del parasitismo intestinal estuvieron presentes en la mayoría de los casos aunque no en todo esto se vinculó al problema de la anemia(AU)

The prevention and control of iron deficiency anemia in the community demands a specialized and careful contribution of nursing staff with an integral approach, rating not only the physical stage but also the mental stage and the social and familiar environment. A descriptive and transversal study was performed about nursing care in children with iron deficiency anemia fro Jesus Menéndez area, Jimmy Hirtzel University Policlinic in Bayamo, from July to December 2007, with the objective to describe the nursing care given in this institution, for the affected children. The sample was constituted by 17 infants under 3 years.The nursing diagnostic that prevailed in the clinic treatment of iron deficiency anemia in children were related to the skin and mucous paleness. The care towards the daily treatment was made in all the cases. The high percent of the involved families received a clear orientation about sources of iron feeding and the importance of a balanced diet. The actions for the control of intestinal parasites were presented in most of the cases although not all of them were attached to thye problem of anemia(EU)

Updating practices in an evolving IV iron and anemia environment: practical solutions.

The latest considerations in the management of iron-deficiency anemia in patients on hemodialysis have centered on the updated guidelines and recommendations issued by the National Kidney Foundation, with interest on appropriate hemoglobin and serum ferritin targets. With practices evolving in the anemia environment, it is necessary for nurses to stay informed of new evidence-based data and practical solutions to improve patient outcomes. This underscores the importance of a team approach to managing anemia and balanced therapy with intravenous iron and erythropoiesis-stimulating agents. A symposium held during the 2007 annual meeting of the American Nephrology Nurses' Association addressed these issues. This article is based on the presentations and discussions from that symposium.