Addressing pre-operative anaemia management

Christoph Springer explains the importance of patient blood management in providing treatment for iron deficiency.

“The treatment of pre-operative anaemia is integral to patient blood management”
-Christoph Springer

How has Vifor Pharma's expertise in providing treatments for iron deficiency helped patients?
Christoph Springer. Vifor Pharma is a leading company in iron therapy and the management and treatment of anaemia and iron deficiency. One of Vifor's leading products is Ferinject (ferric carboxymaltose), a novel formulation of intravenous iron indicated for the treatment of iron deficiency when oral iron preparations are ineffective or cannot be used, and has been shown to rapidly improve haemoglobin levels. Ferinject can be administered by a healthcare professional, and provides a choice of fast administration methods: high single dose drip infusions of up to 1000 mg iron, but not exceeding 15 mg iron/kg body weight, in 15 minutes only or bolus injections of 200 mg iron. This gives Ferinject a dosing flexibility enabling iron replenishment to be adapted to individual needs. Importantly no test dose is required before the administration of Ferinject.

Vifor Pharma's expertise in iron therapy enables it to work with clinicians to develop patient blood management strategies, which identify patients at risk of transfusion and provide a management plan to reduce or even avoid peri-operative transfusions. Patient blood management comprises three elements: the correction of a low pre-operative erythrocyte mass or anaemia; minimising peri-operative erythrocyte loss; and using minimal haemoglobin-based transfusion tiggers Thus, patient blood management can potentially improve patient outcomes and may lead to considerable financial savings as transfusions can be costly due to high blood acquisition and administration costs.

Why is patient blood management important?
CS. Patient blood management has been adopted worldwide by a number of hospitals and health networks, and its success has led to many others considering implementing this strategy. An expert-panel review of the medical literature on blood transfusions at the International Consensus Conference on Transfusion and Outcomes (ICCTO) concluded that the majority of studies show an association between red blood cell transfusions and higher rates of complications such as heart attack, stroke, lung injury, infection, kidney failure and death. Additionally, blood is a precious resource with an ever-limiting supply due to an ageing population.

The treatment of pre-operative anaemia is integral to patient blood management. Pre-operative anaemia is common: over a third (35 percent) of adults scheduled to undergo elective orthopaedic surgery were found to be anaemic at pre-admission testing. Thus, it is recommended that all patients should have their haemoglobin levels assessed at least 30 days before scheduled surgery, and if necessary, should be treated pre-operatively.

Why is it important to treat pre-operative anaemia?
CS. Patients with iron deficiency anaemia prior to surgery are at high risk of receiving a blood transfusion. An Austrian study of 3622 patients undergoing total hip replacement, knee replacement, hemicolectomy or coronary artery bypass graft surgery in 18 hospitals found that 62 percent of anaemic patients needed a blood transfusion compared with 32 percent of non-anaemic patients.

Patients with anaemia who undergo surgery face risk of increased mortality, morbidity and an increased requirement for blood transfusion (and its own associated risks). Treatment options for anaemia linked to iron deficiency are oral or intravenous iron.

Have any healthcare systems already adopted patient blood management?
CS. The Western Australian Government's Department of Health is implementing patient blood management as a standard of care state-wide. Reasons for this include the true cost of blood transfusions, which are estimated to be up to five percent of the Western Australia's public healthcare budget; expected blood shortages because of an ageing population; patients being able to give informed consent for patient blood management; and growing knowledge of the limitations and adverse outcomes with transfusion.

Christoph Springer is Global Head of Anaemia TA Marketing at Vifor Pharma, the Pharma business sector of the Galenica Group, which researches, develops, manufactures and markets pharmaceutical products, with focus on the treatment of iron deficiency. The Swiss-based company is a world leader in this particular field. Christoph is proud of Vifor Pharma’s growing reputation for developing novel medicines that treat unmet needs especially in anaemia.