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Anemia and postoperative rehabilitation
Jeffrey L Carson1, Michael L Terrin, Magaziner Jay
1Division of General Internal Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA. carson@umdnj.edu
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|November 25, 2003
Summary
Treating anemia with erythropoietin improves function and exercise capacity. Optimal hemoglobin levels for functional outcomes are likely near normal, but further research is needed to determine precise targets.
Area of Science:
- Hematology
- Nephrology
- Geriatrics
Background:
- Anemia is common in patients with end-stage renal failure, undergoing surgery, or receiving cancer chemotherapy.
- Published data on anemia's functional impact often come from trials of recombinant human erythropoietin.
- Previous studies, though small, consistently show improvements in fatigue, exercise capacity, and daily living activities with anemia correction.
Purpose of the Study:
- To evaluate the functional outcomes associated with correcting anemia.
- To determine the optimal hemoglobin levels for functional improvement.
- To assess the benefits versus risks of treatments like erythropoietin or blood transfusions.
Main Methods:
- Review of published clinical trials evaluating recombinant human erythropoietin.
- Analysis of functional outcomes including fatigue, exercise capacity, muscle strength, and activities of daily living.
- Comparison of functional performance at different hemoglobin levels.
Main Results:
- Anemia correction consistently improves fatigue, exercise capacity, muscle strength, and daily living activities.
- Cardiac and cognitive functions also show improvement as anemia is treated.
- Exercise performance may plateau at hemoglobin levels between 9-10 g/dL, with some studies showing benefits up to 14 g/dL compared to 10 g/dL.
Conclusions:
- While normal hemoglobin levels (12-14 g/dL) are likely optimal, there may be diminishing returns as levels approach normal.
- The risks and costs of treatment must be weighed against functional benefits.
- Higher hemoglobin levels may enhance postoperative rehabilitation and functional independence in elderly, co-morbid patients, requiring further investigation.