title: Anaemia in elective orthopaedic surgery - Royal Adelaide Hospital, Australia.
abstract: BACKGROUND
  An anaemia clinic was established to improve the preoperative management of elective orthopaedic patients scheduled for arthroplasty. This paper is a report on the first 100 patients assessed.
  
  
  OBJECTIVE
  To assess the incidence and causes of anaemia in patients on a waiting list for elective arthroplasty in a public hospital and to assess the impact of anaemia detection in this patient population.
  
  
  METHODS
  Patients attending an Anaemia Clinic for elective orthopaedic surgical patients, during March 2010 to June 2013 were studied. Outcome measures included change in haemoglobin preoperative results and perioperative transfusion rates by preoperative haemoglobin.
  
  
  RESULTS
  Seventeen per cent of patients scheduled for elective surgery were found to be anaemic. Of the 100 patients who attended, approximately half were found to be iron deficient and the remainder had anaemia of chronic disease. Serum ferritin <30 µg/L alone did not identify iron deficiency in 80% of patients with iron deficiency. Patients with iron deficient anaemia were able to be treated, in all cases, to achieve a significant increase in preoperative haemoglobin. The general unavailability of erythropoietin limited effective intervention for the non-iron-deficient anaemic patients. Seven patients had their surgery cancelled because of the screening programme.
  
  
  CONCLUSIONS
  Half of the anaemic patients in a joint replacement screening clinic were iron deficient, and treatment was effective in improving the pre-operative haemoglobin and reducing perioperative transfusion rates. This screening process should improve patient outcome. Another important finding in this group of patients is that ferritin levels cannot be reliably used as the sole indicator in the diagnosis of iron deficiency anaemia in this group of patients undergoing elective arthroplasty.
authors.affiliation: Site Clinical Director, Royal Adelaide Hospital, SA Pathology, Adelaide, Australia.|Clinical Haematology Service, Royal Adelaide Hospital, Modbury, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Kearney
authors.affiliation: Division of Aged Care, Rehabilitation and Palliative Care, Modbury Hospital, Adelaide, Australia.
authors.forename: J
authors.initials: J
authors.lastname: To
authors.affiliation: Royal Adelaide Hospital, Orthopaedic Surgery and Trauma, Adelaide, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Southam
authors.affiliation: Department of Orthopaedic Surgery and Trauma, University of Adelaide, Royal Adelaide Hospital, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Howie
authors.affiliation: Clinical Haematology Service, Royal Adelaide Hospital, Modbury, Australia.|Clinical Section, Royal Adelaide Hospital Department of Haematology, SA Pathology, Adelaide, South Australia, Australia.
authors.forename: B
authors.initials: B
authors.lastname: To
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D001315:Australia / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006779:Hospitals, Public / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*
keywords: anaemia; arthroplasty; haemoglobin; orthopaedic; transfusion