The anemia correction in chronic diseases in perioperative period while performing prosthesis of aortal valve
Objective. To determine the impact of preoperative correction, using hydroxide of iron (III) erythropoietin, in patients, having the heart aortal failures, complicated by the chronic diseases anemia, on the postoperative anemia after doing the aortal valve prosthesis in accordance to the blood-preserving technology in the artificial blood circulation conditions.
Materials and metods. The investigation was conducted in 83 patients, to whom the aortal valve prosthesis was performed with a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus. All the patients were divided into three Groups in accordance to levels of hemoglobin, iron and the blood-preserving technologies applied. To the Group A 31 patients were included, in whom the initial concentration of hemoglobin, hematocrit and iron was normal. The patients were operated, using the donor’s blood components. To the Group B 37 patients were included, who were operated on without application of the donor’s blood components, using a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus. In the Group C 15 patients were present, who have had initial preoperative anemia of chronic diseases with low values of hemoglobin, hematocrit and iron. Before the preoperative week a preoperative correction of anemia was conducted to them, using hydroxide of iron (III) and erythropoietin. Comparative characteristics of intraoperative application of the aortal valve prosthesis in the donor’s Group A, preoperative combined correction of anemia due to chronic illnesses - in the Group C, and of the blood-preserving technologies - in the Groups B and C are adduced. The impact of intraoperative application while performing the aortal valve prosthesis of the donor’s blood components, preoperative combined correction of the chronic diseases anemia with a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus on the postoperative anemia level were investigated.
Results. The data obtained witness, that in Group A with the objective to stabilize the levels of hemoglobin and hematocrit intraoperatively the donor’s blood components - (568.0 ± 93.0) ml of erythrocytic mass and (596.0 ± 48.0) ml of a fresh frozen plasm were needed, what constitutes 25% of the circulating blood volume. In Group B postoperatively after the aortal valve prosthesis in accordance to the blood-preserving technology without transfusion of the donor’s blood preparations a hemoglobin level have lowered down by 19.9% (p ˂ 0.05), hematocrit - by 17.5% (p ˂ 0.05), and a thrombocytes quantity - by 24.0% (p ˂ 0.05). Correction, performed for preoperative anemia, using hydroxide of iron (III) and erythropoietin to patients, suffering anemia due to chronic diseases in Group C, have had raised a serum iron level in 6.2 times (p ˂ 0.05), ferritin - in 5.4 times (p ˂ 0.05), and hemoglobin - by 6.7%. Performance of the aortal valve prosthesis in accordance to the blood-preserving technologies in conditions of artificial blood circulation without application of the donor’s blood components in patients of Group C have stabilized a postoperative level of the serum iron, hemoglobin and the thrombocytes quantity.
Conclusion. In 18% of the patients, owing the heart aortal failures, the chronic diseases anemia is observed, caused by predominantly rheumatic inflammatory illnesses with moderate anemia and hypoferritinemia. Correction of anemia of chronic diseases, using hydroxide of iron (III) and stimulation of hematopoiesis with erythropoietin in preoperative period have raised the serum iron level in 6.2 times (p ˂ 0.05), coefficient of transferrin saturation by iron - by 41.9% (p ˂ 0.05), a ferritin level - in 5.5 times (p ˂ 0.05). For the levels of hemoglobin and hematocrit stabilization while doing the aortal valve prosthesis operation in patients of Group A the donor’s blood components - (568.0 ± 93.0) ml of erythrocytic mass and (596.0 ± 48.0) ml of the fresh frozen plasm, constituting 25% of the circulating blood volume, - were applied. In the patients of Group В after performance of the aortal valve prosthesis in accordance to the blood-preserving technology the level of hemoglobin by 17.4%, the serum iron - by 15.2% and the thrombocytes quantity - by 24.0% have lowered. Preoperative correction of anemia, using hydroxide of iron (III) and stimulation of hematopoiesis, applying erythropoietin in patients of Group C, to whom the aortal valve prosthesis was done with a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus, have had lowered the postoperative anemia level by 11.7% (p ˂ 0.05).
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