The effect of preoperative blood management on peroperative and postoperative blood product usage in adult patients undergoing open heart surgery. transfusion frequency and its relationship with morbidity

INTRADUCTION: Iron deficiency is the most common nutritional disorder. Iron deficiency and associated anemia continue to exist as a major health problem. Anemia is a very common disease. The incidence in adult patients is reported to be 17%. Unless treated, it is a disease that limits the quality of life and body metabolism and causes undesirable results in the long term. When the underlying cause is determined, the treatment method can be applicable for each patient uniquely. A wide spectrum is applied from oral iron preparations to intravenous treatment methods, and transfusion treatment in necessary patients. Cardiovascular surgery is the type of surgery in which blood loss is most common and transfusion is most frequently applied. Blood loss develops in the perioperative and postoperative period due to some procedures applied during the operation that affect blood coagulation factors and blood cells. Especially in patients with anemia, the fact that surgical procedures are performed without anemia treatment increases the use of excessive blood products and the incidence of related side effects. Especially in recent years, there has been a lot of discussion about blood management. There are many studies that have tested the postoperative results such as mortality, morbidity and blood product usage between patients with and without anemia treatment. In our study, we will present the results of mortality, morbidity and blood product use between the normal patient group and the patient group had anemia treatment. METHODS: 95 patients who were operated under cardiopulmonary bypass were included in the study. 63 of the patients were male and 32 were female. All patients underwent elective open heart surgery. 1000 mg ferric carboxymaltose (2 vials) in 100 cc NaCl 0.9% was applied 1 week before the operation to the patients with iron deficiency. An additional 500 mg ferric carboxymaltose was applied one week after the first dose in patients deemed necessary considering the body mass index. No anemia treatment was applied to the patients whose iron deficiency was not defined. The patients evaluated in two main groups as treated and untreated patients. Except for insensible losses, all blood losses and values measured during cardiopulmonary bypass (administered heparin amount, operation time, cardiopulmonary bypass time, clamp time, postoperative cardiopulmonary bypass balance, and amount of blood product administered during the operation) were recorded. Postoperative drainage was followed up during the intensive care unit stay. The amount of blood product used was recorded. Intensive care unit stays, intubated stays and total hospitalization times were recorded. Hematocrit, hemoglobin, platelet and CRP values were monitored on the 1st and 10th days, respectively. RESULTS: Ferric carboxymaltose treatment was administered to 25 patients who were diagnosed with anemia with appropriate criteria as a result of the preoperative evaluation. There was no significant difference between patients with and without anemia in terms of age and gender distribution. Height, weight and BMI values did not differ significantly between patients with and without anemia. The rate of CABG surgery in patients treated with anemia was significantly lower than the other patient group. When the treated and non-anemia patients were compared, there was no significant difference in the duration of CBP and CC. The operation time of the patients who were treated for anemia was significantly lower. Preoperative, perioperative, postoperative hemoglobin, preoperative and postoperative hematocrit and preoperative CRP values were significantly lower in patients with anemia compared to patients without anemia. There was no significant difference in platelet values. There was no significant difference in preoperative TIBC, ferritin, EF, creatinine, TSH, T3, T4 values between patients with and without anemia. The heart rates of the patients with anemia were significantly higher than the patients in the other group. Preoperative MCV value was significantly lower in patients with anemia. No significant difference was observed in the amount of postoperative drainage between the patients who were treated for anemia and those without anemia. The rate of preoperative anticoagulant/antiaggregant drug use was significantly higher in patients treated for anemia compared to other patients. When patients with and without anemia were compared, no significant difference was observed in the rate of comorbidities. The rate of having heart failure in the anemic patient group was significantly higher than the non-anemic patients. When patients with and without anemia were compared, the incidence of ischemic heart disease was significantly lower in anemic patients. The incidence of aortic valve disease and infective endocarditis was significantly higher in patients with anemia. The amount of ES and FFP used perioperatively was significantly higher in patients treated with anemia compared to other patients. There was no significant difference in the amount of ES and FFP use in the postoperative period between the patients who were treated and not treated with anemia. There was no significant difference in intensive care unit length of stay, intubated stay time, and hospitalization time between patients who were treated for anemia and those without anemia. Also the incidence of complications did not differ significantly between the same patient groups. CONCLUSION: In our study, it was observed that patients treated with anemia preoperatively with ferric carboxymaltose required similar amounts of transfusion need in the preoperative and postoperative period with the other patients. The patients had similar mortality and morbidity in the postoperative period. They underwent similarly comfortable intensive care unit stay regardless of whether they were treated for anemia or not.