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| 1 | Perioperative anemia management in colorectal cancer patients:A pragmatic approach显示文摘Anemia,usually due to iron deficiency,is highly prevalent among patients with colorectal cancer.Inflammatory cytokines lead to iron restricted erythropoiesis further decreasing iron availability and impairing iron utilization.Preoperative anemia predicts for decreased survival.Allogeneic blood transfusion is widely used to correct anemia and is associated with poorer surgical outcomes,increased post-operative nosocomial infections,longer hospital stays,increased rates of cancer recurrence and perioperative venous thromboembolism.Infections are more likely to occur in those with low preoperative serum ferritin level compared to those with normal levels.A multidisciplinary,multimodal,individualized strategy,collectively termed Patient Blood Management,minimizes or eliminates allogeneic blood transfusion.This includes restrictive transfusion policy,thromboprophylaxis and anemia management to improve outcomes.Normalization of preoperative hemoglobin levels is a World Health Organization recommendation.Iron repletion should be routinely ordered when indicated.Oral iron is poorly tolerated with low adherence based on published evidence.Intravenous iron is safe and effective but is frequently avoided due to misinformation and misinterpretation concerning the incidence and clinical nature of minor infusion reactions.Serious adverse events with intravenous iron are extremely rare.Newer formulations allow complete replacement dosing in 15-60 min markedly facilitating care.Erythropoiesis stimulating agents may improve response rates.A multidisciplinary,multimodal,individualized strategy,collectively termed Patient Blood Management used to minimize or eliminate allogeneic blood transfusion is indicated to improve outcomes. | Manuel Muoz Susana Gómez-Ramírez Elisa Martín-Montaez Michael Auerbach | 2014 | World Journal of Gastroenterology2014，20，8： | 8 |
| 2 | Iron deficiency anemia in inflammatory bowel disease显示文摘Anemia is a common extraintestinal manifestation of inflammatory bowel disease(IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia(IDA) secondary to chronic blood loss, and impaired iron absorption due to tissue inflammation. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with IBD must be regularly monitored for earlier detection of anemia. IDA in IBD is associated with poor quality of life, necessitating prompt diagnosis and appropriate treatment. IDA is often associated with inflammation in patients with IBD. Thus, commonly used labora-tory parameters are inadequate to diagnose IDA, and newer iron indices, such as reticulocyte hemoglobin content or percentage of hypochromic red cells or zinc protoporphyrin, are required to differentiate IDA from anemia of chronic disease. Oral iron preparations are available and are used in patients with mild disease activity. These preparations are inexpensive and con-venient, but can produce gastrointestinal side effects, such as abdominal pain and diarrhea, that limit their use and patient compliance. These preparations are partly absorbed due to inflammation. Non-absorbed iron can be toxic and worsen IBD disease activity. Although cost-effective intravenous iron formulations are widely available and have improved safety profiles, physicians are reluctant to use them. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD. | Sindhu Kaitha Muhammad Bashir Tauseef Ali | 2015 | World Journal of Gastrointestinal Pathophysiology2015，6，3： | 3 |
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