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. 2023 Apr 1;277(4):581-590.
doi: 10.1097/SLA.0000000000005721. Epub 2022 Sep 21.

Recommendations From the International Consensus Conference on Anemia Management in Surgical Patients (ICCAMS)

Aryeh Shander  1   2 , Howard L Corwin  3 , Jens Meier  4   5 , Michael Auerbach  6   7 , Elvira Bisbe  5   8 , Jeanna Blitz  9 , Jochen Erhard  10 , David Faraoni  11 , Shannon L Farmer  12   13 , Steven M Frank  14 , Domenico Girelli  15 , Tiffany Hall  16 , Jean-François Hardy  5   17 , Axel Hofmann  18 , Cheuk-Kwong Lee  19 , Tsin W Leung  20 , Sherri Ozawa  21 , Jameela Sathar  22 , Donat R Spahn  23 , Rosalio Torres  24 , Matthew A Warner  25 , Manuel Muñoz  26
Affiliations

Recommendations From the International Consensus Conference on Anemia Management in Surgical Patients (ICCAMS)

Aryeh Shander et al. Ann Surg. .

Abstract

Background: Perioperative anemia has been associated with increased risk of red blood cell transfusion and increased morbidity and mortality after surgery. The optimal approach to the diagnosis and management of perioperative anemia is not fully established.

Objective: To develop consensus recommendations for anemia management in surgical patients.

Methods: An international expert panel reviewed the current evidence and developed recommendations using modified RAND Delphi methodology.

Results: The panel recommends that all patients except those undergoing minor procedures be screened for anemia before surgery. Appropriate therapy for anemia should be guided by an accurate diagnosis of the etiology. The need to proceed with surgery in some patients with anemia is expected to persist. However, early identification and effective treatment of anemia has the potential to reduce the risks associated with surgery and improve clinical outcomes. As with preoperative anemia, postoperative anemia should be treated in the perioperative period.

Conclusions: Early identification and effective treatment of anemia has the potential to improve clinical outcomes in surgical patients.

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Conflict of interest statement

M.A. has received research funding for data management from Covis Pharmaceuticals (formerly AMAG) and has participated in educational, nonpromotional programs for Pfizer and Pharmacosmos. E.B. has received honoraria from Vifor Pharma and Sysmex for giving lectures. H.L.C. has received honoraria from American Regent. J.E. has received payment from Vifor Pharma for giving lectures. S.F. has received honoraria from Ethicon Biosurgery for giving lectures, and funding from National Blood Authority (Australia) for traveling to and attending meetings. S.M.F. has received honoraria from Haemonetics for scientific advisory board participation. D.G. has received honoraria from Vifor Pharma, for advisory board participation. A.H. received fees, honoraria, or travel costs for consultancy or lecturing from Celgene, G1 Therapeutics, International Foundation for Patient Blood Management, PBMe Solutions, South African National Blood Service, Takeda, TEM and Vifor. J.F.H. has received honoraria from Pharmacosmos for consultancy and scientific presentations, and from Nordic Pharma for consultancy. J.M. received a project-linked scientific grant from Vifor Pharma. M.M. has received honoraria for lectures and/or consultancy from Pharmacosmos, Vifor Pharma, and PharmaNutra. S.O. has received honoraria from Baxter Healthcare for consultancy. A.S. has received honoraria for consultancy and/or serving as a speaker for Merck, AMAG, Masimo Corp, CSL Behring, Vifor Pharma, Pharmacosmos, Pharmaniaga, Accumen and I-SEP, and has received research grants from Masimo Corp, CSL Behring, HbO2 Therapeutics and Werfen. D.R.S. has received honoraria/travel support for consulting or lecturing from Danube University of Krems (Austria), US Department of Defense, European Society of Anaesthesiology, Korean Society for Patient Blood Management, Korean Society of Anesthesiologists, Network for the Advancement of Patient Blood Management, Alexion Pharmaceuticals, Baxalta Switzerland, Bayer, B. Braun Melsungen, Boehringer Ingelheim, Bristol-Myers-Squibb, CSL Behring, Celgene International, Daiichi Sankyo, Haemonetics, Instrumentation Laboratory (Werfen), LFB Biomédicaments, Merck Sharp & Dohme, Novo Nordisk Health Care, PAION Deutschland, Pharmacosmos, Pfizer, Pierre Fabre Pharma, Portola Schweiz, Roche Diagnostics International, Sarstedt, Shire, Tem International, Vifor Pharma, Vifor International and Zuellig Pharma. R.T. has received honoraria from Zuellig Pharma for giving lectures. M.A.W. receives research support through the National Heart, Lung, and Blood Institute of the National Institutes of Health (K23HL153310). The remaining authors report no conflicts of interest.

Figures

None
Graphical abstract
FIGURE 1
FIGURE 1
Prevalence of preoperative anemia: variations across surgical settings. This figure has been adapted from Muñoz et al (publisher: SIMTI Servizi Srl) in accordance with the terms and conditions of the Creative Commons Attribution license. Adaptations are themselves works protected by copyright. So, to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.
FIGURE 2
FIGURE 2
Meta-analysis of preoperative intravenous (IV) iron for preoperative correction of anemia in patients undergoing major surgery: comparisons of the effects of IV iron therapy versus placebo/standard care or oral iron on proportion of participants receiving allogeneic blood transfusion (A, B); preoperative hemoglobin levels (g/dL; C, D); and hemoglobin levels >4 weeks postoperatively (g/dL; E). A, Comparison with placebo/standard care. B, comparison with oral iron. C, Comparison with placebo/standard care. D, Comparison with oral iron. E, Comparison with placebo/standard care. This figure has been adapted from Elhenawy et al (publisher: BioMed Central Ltd, part of Springer Nature) in accordance with the terms and conditions of the Creative Commons Attribution license. Adaptations are themselves works protected by copyright. So, to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.
See this image and copyright information in PMC

References

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