Correction of Postoperative Anemia in Patients undergoing Mitral Valve Replacement through Blood Saving Technology

DOI: https://doi.org/10.30702/ujcvs/20.4009/038055-060/5.16
Keywords: anemia, iron (III) hydroxide, erythropoietin, mitral heart disease, blood saving technology, artificial circulation

Abstract

The aim. To investigate anemia of chronic disease (ACD) in patients with mitral valvular disease, to provide preoperative correction in these patients and to determine the level of postoperative anemia after mitral valve replacement (MVR) through blood saving technology (BST) under artificial circulation (AC).
Materials and methods. This is a study of 104 patients operated due to acquired mitral heart defects under AC. According to the baseline Hb, Ht, serum iron (SI) as well as the use of BST during MVR, all the patients were divided into 3 groups. Group A included 47 patients with normal Hb concentration, Ht and SI, who underwent the surgical intervention without BST with blood transfusion. Group B included 35 patients without ACD who were operated without blood transfusion with the use of BST. The group C included 22 patients with preoperative ACD with low Hb, Ht, and SI. A week before surgery the patients of group C underwent preoperative correction of SI and erythropoiesis stimulation using erythropoietin. The patients of group C were operated using BST. Preoperative correction of anemia and the use of blood and BST during surgery in groups A, B, C were compared. The effect of preoperative ACD correction and erythropoiesis stimulation on the level of postoperative anemia in patients operated due to mitral heart disease through BST in group C and with or without correction in group B was studied.
Results. The presented research results show that in group A, in order to sufficiently stabilize the level of Hb and Ht during the operation, donated blood components (590.0 ± 83.0 ml of packed red blood cells and 563.0 ± 68.0 ml of fresh frozen plasma) were used. The use of BST in the group B reduced the level of Hb by 17.4%, Ht by 15.8%, thrombocyties by 20.5%, and the intervention could be performed without donated blood transfusion. Preoperative correction of SI and administration of erythropoietin in patients with ACD resulted in 8.6-fold increase in SI, 5.5-fold increase in ferritin and increase in Hb by 8.1% before the intervention. The use of BST and hematopoietic technology during MVR in patients of group C stabilized SI, Hb and platelets in the operative period, which facilitates operations under AC without transfusion of donated blood components.
Conclusions.
1. In patients of group A, donor blood components (590.0 ± 83.0 ml of packed red blood cells and 563.0 ± 68.0 ml of fresh frozen plasma) were used to stabilize Hb and Ht during MVR without the use of BST.
2. ACD correction in patients of group C with mitral heart disease has led to a 8.6-fold increase in SI (p˂0.05), increase in transferrin saturation coefficient by 36.8% (p˂0.05), and 5.5-fold increase in ferritin activity (p˂0.05).
3. The use of BST in patients of group B undergoing MVR reduces the level of Hb by 17.4% (* p˂0.05) and platelets by 20.5% (* p˂0.05).
4. Preoperative correction of SI with iron (III) hydroxide and hemapoiesis stimulation by erythropoietin in patients of group C with MVR using BST reduces anemia by 10.7% and thrombocytopenia by 5%.

References

  1. Гуменюк БМ. Виявлення маркерів інфекції, що передаються через кров у донорів та пацієнтів кардіохірургічного стаціонару. Щорічник наукових праць Асоціації серцево-судинних хірургів України. 2011;19:122-5.
  2. Gumenyuk BM. [Detection of Markers of Infections that are Transmitted Throughdonors Blood to Cardiac Surgery Patients Hospital]. The yearbook of scientific works of Ukrainian Society of Cardiovascular Surgery. 2011;19:122–5. Ukrainian.
  3. Хубутия МШ, Солонин СА, Баженов АИ, Кобзева ЕН, Смирнова ЮВ, Годков МА. Риски передачи гемоконтактных вирусных инфекций при гемотрансфузиях, трансплантации органов и тканей. Трансплантология. 2015;4:23-33.
  4. Khubutiya MSh, Solonin SA, Bazhenov AI, Kobzeva EN, Smirnova YuV, Godkov MA. [Risks of transmitting blood-borne viral infections via blood transfusion, organ and tissue transplantation]. Transplantologia. 2015;4: 23–33. Russian.
  5. Гематологія і переливання крові: міжвідомчий збірник. Вип. 38. Київ; 2015.
  6. [Hematology and blood transfusion: interdepartamental collection]. 38th ed. Kyiv; 2015. Ukrainian.
  7. Lewis CE, Hiratzka LF, Woods SE, Hendy MP, Engel AM. Autologous blood transfusion in elective cardiac valve operations. J Card Surg. 2005 Nov-Dec;20 (6):513-8. https://doi.org/10.1111/j.1540-8191.2005.00137.x
  8. Kozek-Langenecker SA, Ahmed AB, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016. Eur J Anaesthesiol. 2017;34(6):332-95. https://doi.org/10.1097/EJA.0000000000000630
  9. Naito Y, Tsujino T, Matsumoto M, Sakoda T, Ohyanagi M, Masuyama T. Adaptive response of the heart to long-term anemia induced by iron deficiency. Am J Physiol Heart Circ Physiol. 2009 Mar;296(3):H585-93. https://doi.org/10.1152/ajpheart.00463.2008
  10. Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009 Dec 17;361(25):2436-48. https://doi.org/10.1056/NEJMoa0908355
  11. Curley GF, Shehata N, Mazer CD, Hare GM, Friedrich JO. Transfusion triggers for guiding RBC transfusion for cardiovascular surgery: a systematic review and meta-analysis. Crit Care Med. 2014;42(12):2611-24. https://doi.org/10.1097/CCM.0000000000000548
  12. Лазоришинец ВВ, Попов ВВ, Гуменюк БН, Дьяченко ВЛ. Кровесберегающая технология в хирургии митральных пороков сердца. Кардиология в Беларуси. 2016;8(3):21-5.
  13. Lazorishinetz V, Popov V, Gumenyuk B, Dyachenko V. [Bloodsaving technology in surgery of mitral heart defects]. Cardiology in Belarus. 2016;8(3):21-5. Russian.
  14. Долинна ОВ. Патогенез та шляхи корекції анемічного синдрому у пацієнтів з хронічною серцевою недостатністю. Сімейна медицина. 2016;(1):58-62.
  15. Dolynna OV. [Pathogenesis and ways of correcting anemia syndrome in patients with chronic heart failure]. Simeina medytsyna. 2016;(1):58-62. Ukrainian.
  16. Ускач ТМ, Кочетов АГ, Терещенко СН. Клинико-статистический анализ распространённости анемии у пациентов с хронической сердечной недостаточностью. Кардиология. 2011;1:11-7.
  17. Uskach TM, Kochetov AG, Tereschenko SN. [The Statistical Analysis of Prevalence of Anemia in Patients With Chronic Heart Failure]. Kardiologiia. 2011;1:11–7. Russian.
  18. O`Meara E, Clayton T, McEntegart M, McMurray JJ, Lang CC, Roger SD, et al. Clinical Correlates and Consequences of Anemia in a Broad Spectrum of Patients with Heart Failure: Results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Circulation. 2006;113(7):986–94. https://doi.org/10.1161/CIRCULATIONAHA.105.582577
Published
2020-09-18
How to Cite
Gumeniuk, B. M. (2020). Correction of Postoperative Anemia in Patients undergoing Mitral Valve Replacement through Blood Saving Technology. Ukrainian Journal of Cardiovascular Surgery, (3 (40), 55-60. https://doi.org/10.30702/ujcvs/20.4009/038055-060/5.16
Issue
Ukrainian Journal of Cardiovascular Surgery No 3 (40) 2020
Section
ACQUIRED HEART DISEASES