Diagnosis
The diagnosis of anemia can be made after taking a blood sample and subsequent examination of the blood count. The doctor pays particular attention to the haemoglobin value (see above), the haematocrit value (see above) and the total number of red blood cells. By means of a physical examination, the doctor can determine typical symptoms of anemia such as paleness of the mucous membranes or eyelid crease.
Therapy
If severe acute bleeding occurs intraoperatively, the patient must be treated with blood transfusions to ensure the oxygen supply to all organs. The administration of foreign blood during an operation does not affect the occurrence of postoperative anemia. If anemia occurs after an operation, blood formation can be stimulated by supportive therapies.
The administration of iron and erythropoietin is possible. The theoretical total iron requirement can be calculated using a simple formula: Iron requirement=150 ×(hemoglobin target hemoglobin initial value) Iron can be administered in the form of tablets, intramuscular injections or intravenous infusions. The administration of tablets is an inexpensive and simple procedure, but the iron given in this way cannot be optimally absorbed through the intestine and causes side effects such as heartburn, vomiting, diarrhoea, constipation and abdominal pain.
Iron tablets are best taken before meals, otherwise iron absorption is reduced. Black tea, coffee and milk almost completely prevent iron absorption in the intestines. The intravenous administration of iron saccharate as a short infusion has few side effects.Erythropoietin is a hormone that stimulates blood production and is available in recombinant form.
It is used as a supplement when anemia does not respond or responds only insufficiently to the administration of iron preparations. The iron preparations must continue to be taken even under therapy with erythropoietin, otherwise iron deficiency can occur due to increased blood production. Erythropoietin can also be administered pre- and postoperatively to raise the hemoglobin level, but therapy with erythropoietin must be adjusted individually due to the high costs involved.
Iron replacement may be useful in many cases for the treatment of postoperative anemia. In general, iron deficiency is the most common trigger of anemia, but there are also a variety of other causes. After an operation, there is usually an increase in inflammatory messengers as a reaction of the body to the operation.
One of many effects of these messengers is that the absorption of iron from food through the intestines is reduced. Especially in patients who already have borderline filled iron reserves before surgery, this can trigger postoperative anemia. In addition, the body loses additional iron through blood loss during surgery.
The doctor can determine whether an iron deficiency is the cause of postoperative anemia by means of special blood value determinations of iron storage proteins. If the results indicate an iron deficiency, temporary iron substitution is indicated. However, if the cause is different, this is not appropriate and other measures may be necessary. In any case, your doctor should check your blood count and other relevant values in the course of the treatment.
