CPOC: Anaemia

Question 1

Types of anaemia

Answer 1

Iron deficiency anaemia
- Due to excessive bleeding: menstruation, GI loss (cancer, chronic NSAID use)
- Due to reduced intake: diet deficient, poor absorption IBD, coeliac disease, previous bariatric surgery

Anaemia related to inflammation
- CKD
- Heart failure
- RA
- IBD

Megaloblastic anaemia
- B12 or folate deficiency: diet deficiency, alcoholism, pernicious anaemia, medications (PPI, metformin, colchicine)

Inherited blood disorders
- Sickle cell
- Thalassaemia

Question 2

Further tests if the patient is anaemic

Answer 2

• Iron studies: ferritin, T-Sat
• Haemitinics: B12, folate
• Reticulocytes
• U&Es
• CRP

Consider: TSH, coeliac testing, endoscopy, G&S, LFTs, urine dipstick

Question 3

Blood profile of iron deficiency anaemia

Answer 3

• Ferritin <30
• T-SAT <20%

Question 4

Blood profile of anaemia of chronic disease

Answer 4

• Ferritin 30-100 and CRP >5 or eGFR <60

Question 5

Blood profile of Vit B12/ folate deficient anaemia

Answer 5

• Ferritin > 100
• T-Sat >20
• B12 or folate low

Question 6

Treatment options for anaemia

Answer 6

• Dietary improvements: red meat, shellfish, legumes
• Oral iron: four weeks to be effective, consider alternate day dosing
• IV iron: needs monitoring, extravasation causes skin discolouration
• B12 and folate: IM B12 injection 1mg 3x per week
• Blood transfusion: risk of allogenic transfusion
• Tranexamic acid
• EPO

Question 7

Transfusion thresholds for neonates

Answer 7

Week One
On oxygen <120g/L
Off oxygen <100g/L

Week Two
On oxygen <100g/L
Off oxygen <85g/L

Week Three and onwards
On oxygen <85g/L
Off oxygen <75g/L

Question 8

Surgery with a high risk of significant bleeding

Answer 8

• Neurosurgery
• Cardiac surgery
• Mafor intra-abdominal: anastomotic work
• Major vascular: Bypass or AAA
• Major orthopaedic: hip or knee replacement
• Lung resection
• Urology: prostatectomy, bladder tumour resection
• Extensive cancer surgery
• Certain biopsies: renal, prostate, cervix, colonic, pericardial

Question 9

Who should have a FBC checked pre-operatively

Answer 9

• Moderate surgery and ASA III or IV
• Major surgery

Question 10

Goals of patient blood management

Answer 10

1. Detection and management of anaemia and iron deficiency
2. Minimisation of blood loss and optimisation of coagulation
3. Optimising and leveraging the patient’s physiological tolerance of anaemia