preoperative anaemia in the paediatric patient: a south
TRANSCRIPT
![Page 1: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/1.jpg)
Preoperative Anaemia in the Paediatric Patient:
A South African Perspective
Dr. Heidi MeyerRed Cross War Memorial Children’s Hospital
![Page 2: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/2.jpg)
DISCLOSURESNone
![Page 3: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/3.jpg)
Comprehensive Anaemia
Management
MinimisingBlood Loss
Rationale Management of Haemotherapy
Patient Blood Management
![Page 4: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/4.jpg)
“Red-cell-containing components should not be used to
treat anaemias that can be corrected with specific
haematinic medications such as iron, vitamin B12, folic
acid, or erythropoietin.”1
![Page 5: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/5.jpg)
Preoperative Anaemia in Paediatric Patients
Worse outcomes?How common is it?Screening?Effectively treat anaemia?
Does correcting anaemia improve outcomes?
![Page 6: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/6.jpg)
WHO Definition of Anaemia2
![Page 7: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/7.jpg)
Preoperative Anaemia and Outcomes:Paediatric Noncardiac Surgery
Increased postoperative mortality(OR 1.75, 95% CI, 1.15–2.65)3
Increased postoperative morbidity(OR 1.99, 95% CI 1.28-3.10)4
Increased perioperative transfusion(OR 3.60, 95% CI 1.83-7.05)4
![Page 8: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/8.jpg)
Anaemia46.2%
No Anaemia53.8%
Anaemia No Anaemia
Mild Anaemia36.9%
Moderate Anaemia60.0%
Severe Anaemia 3.1%
Mild Anaemia Moderate Anaemia Severe Anaemia
Prevalence of Preoperative Anaemia in SAPSOS4
![Page 9: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/9.jpg)
Variables Anaemic (n = 505) Nonanaemic (n = 589) P ValueHaemoglobin (median, IQR) 10.2 (9.4 - 10.8) 12.4 (11.9 - 13.5) <0.001 Age group (y), n/N (%)
³0.5-1 29/53 (54.7) 24/53 (45.3)³1-4 147/262 (56.1) 115/262 (43.9)³4-13 279/669 (41.7) 390/669 (58.3)³13-16 50/110 (45.5) 60/110 (54.5) 0.001
ASA physical status, n/N (%)1 310/720 (43.1) 410/720 (56.9)2 105/228 (46.1) 123/228 (53.9)³3 87/141 (61.7) 54/141 (38.3) <0.001
Co-morbidity, n/N (%)HIV/AIDS 23/34 (67.6) 11/34 (32.4) 0.013
Grade of surgery, n/N (%)Minor 244/529 (48.5) 285/529 (53.9)
Intermediate 227/491 (45.0) 264/491 (53.8)Major 31/71 (43.7) 40/71 (56.3) 0.199
Urgency of surgery, n/N (%)Elective 279/647 (43.1) 368/647 (56.9)Urgent 134/261 (51.3) 127/261 (48.7)
Emergency 92/186 (49.5) 94/186 (50.5) 0.918
![Page 10: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/10.jpg)
Prevalence (%) of Anaemia in South African Hospitals
47.8
28
71
40.8
24
46.2
0 10 20 30 40 50 60 70 80
Marsicano D et. al. 2018, Noncardiac Surgery (8)
Conradie W et. al. 2020, Noncardiac Surgery (7)
Jadhunandan K et. al. 2020, Open intraabdominal Surgery (6)
ADULT STUDIES
Wege M 2015, 6m to 36m Acute Hospital Admissions (5)
(Faraoni D et. al. 2016, 1yr to <18yrs, Noncardiac Surgery) (3)
Meyer HM et. al. 2020, 6m to <16yrs, Noncardiac Surgery (4)
PAEDIATRIC STUDIES
![Page 11: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/11.jpg)
SAVACG survey (1994)9
Anaemia 21.4%IDA 5%
n= 4 494
Primary Schools Feeding Scheme
(1994)
![Page 12: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/12.jpg)
SAVACG survey (1994)Anaemia 21.4%
IDA 5%n= 4 494
Primary Schools Feeding Scheme
(1994)
Food Fortification Programme
(2003)
![Page 13: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/13.jpg)
SAVACG survey (1994)Anaemia 21.4%
IDA 5%n= 4 494
NFCS-FB-I (2005)10
Anaemia 28.9%IDA 7.6%
n= ?
Primary Schools Feeding Scheme
(1994)
Food Fortification Programme
(2003)
![Page 14: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/14.jpg)
SANHANES-1 (2013)11
Anaemia 18.8%IDA 8.1%
n= 511
SAVACG survey (1994)Anaemia 21.4%
IDA 5%n= 4 494
NFCS-FB-I (2005)Anaemia 28.9%
IDA 7.6%n= ?
Primary Schools Feeding Scheme
(1994)
Food Fortification Programme
(2003)
![Page 15: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/15.jpg)
SAVACG survey (1994)Anaemia 21.4%
IDA 5%n= 4 494
NFCS-FB-I (2005)Anaemia 28.9%
IDA 7.6%n= ?
SANHANES-1 (2013)Anaemia 18.8%
IDA 8.1%n= 511
Primary Schools Feeding Scheme
(1994)
Food Fortification Programme
(2003)
DHS (2016)12
Anaemia 61.3%IDA ?
n= 1 094
National School Deworming Programme
(2016)
![Page 16: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/16.jpg)
13
![Page 17: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/17.jpg)
![Page 18: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/18.jpg)
Screening ForIron Deficiency Anaemia in Children
Bone marrow
MCV
Serum Ferritin
Transferrin Saturation
Reticulocyte Haemoglobin Content
![Page 19: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/19.jpg)
Serum Ferritin
WHO definitions14
< 12 μg/L in children < 5 years< 15 μg/L in children ≥ 5 years
If CRP > 5
< 30 μg/L in children < 5 years < 70 μg/L in children ≥ 5 years
![Page 20: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/20.jpg)
Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia15
Adjusted ferritin = unadjusted ferritin − β1(CRPobs − CRPref) − β2(AGPobs − AGPref)
![Page 21: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/21.jpg)
Estimating the Burden of Iron Deficiency Anaemia Among African Children16
• 4853 children aged 0–8 years• Kenya, Uganda, Burkina Faso, South
Africa, and The Gambia
WHO definition vs BRINDA
Other iron biomarkers vs BRINDA
![Page 22: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/22.jpg)
![Page 23: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/23.jpg)
![Page 24: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/24.jpg)
Reticulocyte Haemoglobin Content (CHr) to Detect Iron Deficiency in Hospitalised Children in SA17
• Functional iron available for erythropoiesis
• Not affected inflammation
69% anaemic58% IDACHr <29 pg vs TSAT ≤25% (Sensitivity 86%, Specificity 50%)
![Page 25: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/25.jpg)
“ the simplest answer is most often correct.”
![Page 26: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/26.jpg)
![Page 27: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/27.jpg)
![Page 28: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/28.jpg)
Helminths
HookwormSchistosomesAscariasisTrichuris
Mebendazole• Single dose 30.8% vs Multiple dose 96.1%18
Albendazole + Praziquantel
![Page 29: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/29.jpg)
![Page 30: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/30.jpg)
Craniosynostosis Studies
Author Type of Study
Study Size Intervention (n) Control (n) Results
Helfaer et al 199819Case-Control 60 EPO + Iron (30)
No Intervention (30)
Decreased Transfusion,
Increased Hct
Meneghini et al 200320
Case-Control 25 EPO + Iron + ANH (16)
No Intervention (9)
Decreased Transfusion,
Meara et al 200521Case-Control 19 EPO + Iron + Vit K(10)
No Intervention (9)
Decreased Transfusion,
Increased Hct
Krajewski et al 200822Case-Control 79 EPO + CS + Iron (41) Iron (38)
Decreased Transfusion,
Increased Hct
Vega et al 201423Case-Control 60
CHoR Protocol: EPO + Iron + CS (32)
No Intervention (28)
Decreased Transfusion,
Increased Hb
Escher et al 201924Case-Control 36
Minnesota Protocol: EPO + Iron + TXA (14)
No Intervention (22)
Decreased Transfusion,
Increased Hb
![Page 31: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/31.jpg)
Preoperative Haemoglobin and Perioperative Transfusion in Scoliosis Surgery After Iron Supplementation25
382 patientsIron Clinic4mg.kg-1.day-1
Duration of iron therapy
Hb>13.0 associated with decreased transfusion requirements
Transfusion vs No Transfusion46 days 55 days
[IQR 35-85] [IQR 32-70]
![Page 32: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/32.jpg)
![Page 33: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/33.jpg)
Primary Endpoint27:
Days alive and out of hospital from surgery to 30 days following operation
Primary Endpoints26:
Requirement for allogenic red cell transfusion
Mortality up to 30 days after surgery
![Page 34: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/34.jpg)
Preoperative IV Iron to Treat Anaemia in Major Surgery25
No difference• Transfusion 68 (29%) vs. 67 (28%), p = 0.92• Death 2 (1%) vs. 2 (1%), p = 1.0• Anaemia was corrected in 42 (21%) of 244 patients in the IV iron group
Dose?Timing?Included anaemia due to other causes?
![Page 35: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/35.jpg)
![Page 36: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/36.jpg)
Craniosynostosis Studies
Author Type of Study
Study Size Intervention (n) Control (n) Results
Helfaer et al 199819Case-Control 60 EPO + Iron (30)
No Intervention (30)
Decreased Transfusion,
Increased Hct
Meneghini et al 200320
Case-Control 25 EPO + Iron + ANH (16)
No Intervention (9)
Decreased Transfusion,
Meara et al 200521Case-Control 19 EPO + Iron + Vit K(10)
No Intervention (9)
Decreased Transfusion,
Increased Hct
Krajewski et al 200822
Case-Control 79 EPO + CS + Iron (41) Iron (38)
Decreased Transfusion,
Increased Hct
Vega et al 201423Case-Control 60
CHoR Protocol: EPO + CS (32)
No Intervention (28)
Decreased Transfusion,
Increased Hb
Escher et al 201924Case-Control 36
Minnesota Protocol: EPO + Iron + TXA (14)
No Intervention (22)
Decreased Transfusion,
Increased Hb
![Page 37: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/37.jpg)
Erythropoetin?
600 U/kg weekly for 3-4 weeks19-24
e.g. 10kg child 18 000 units
EPOPrice (Rand) Adjust
1 April 2018
2 000 IU 48.62
4 000 IU 72.23
10 000 IU 221.93
30 000 IU 726.32
18 000 IU 870.78
Red Cell Concentrate = R1 426.73
![Page 38: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/38.jpg)
The Future….
Prevalence of iron deficiency anaemia in paediatric surgical patients in SA?
The role of iron (PO/IV) in preoperative anaemia in children?
Preoperative clinic an opportunity for screening for anaemia?
Introduce screening for Hb for anaemia, oral iron, and deworming?
The role of EPO?
SAPSOS-2?
![Page 39: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/39.jpg)
Thank You
![Page 40: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/40.jpg)
References1. Rössler J, Kaserer A, Spahn GH, Spahn DR. Not all anemia is solely due to iron deficiency. J Thorac Dis.
2020;12(3):1130-1132. doi:10.21037/jtd.2019.12.129
2. WHO, Chan M. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switz World Heal Organ. 2011:1-6. doi:2011
3. Faraoni D, Dinardo JA, Goobie SM. Relationship between preoperative anemia and in-hospital mortality in children undergoing noncardiac surgery. Anesth Analg. 2016;123(6):1582-1587. doi:10.1213/ANE.0000000000001499
4. Meyer HM, Torborg A, Cronje L, et al. The association between preoperative anaemia and postoperative morbidity in paediatric surgical patients: A secondary analysis of a prospective observational cohort study. Pediatr Anesth. 2020. doi:10.1111/pan.13872
5. Wege M. A retrospective review of the prevalence and management of anaemia in children in at Red Cross War Memorial Children’s Hospital. 2015.
6. Jadhunandan K, Moodley Y, Gopalan PD. Preoperative anaemia in patients undergoing open intra-abdominal surgery at a South African tertiary hospital. South African J Anaesth Analg. 2020;26(1):24-29. doi:10.36303/SAJAA.2020.26.1.2250
![Page 41: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/41.jpg)
References7. Conradie WS, Biesman-Simons T, Roodt F, et al. A multicentre prospective observational study of the
prevalence of preoperative anaemia and iron deficiency in adult elective surgical patients in hospitals in Western Cape Province, South Africa. South African Med J. 2020;110(1):65-68. doi:10.7196/SAMJ.2020.v110i1.14051
8. Marsicano D, Hauser N, Roodt F, et al. Preoperative anaemia and clinical outcomes in the south africansurgical outcomes study. South African Med J. 2018;108(10):839-846. doi:10.7196/SAMJ.2018.v108i10.13148
9. Labadarios D, Van Middelkoop A. Children aged 6-71 months in South Africa, 1994: their anthropometric, vitamin A, iron and immunisation coverage status. The South African vitamin A consultative group (SAVACG), 1995.
10. Labadarios D, Louw R. Selected micronutrient status, iron status. In: Labadarios D, editor. National Food Consumption Survey-Fortification Baseline (NFCS-FB): South Africa, 2005. Tygerberg: University of Stellenbosch, 2007; p. 447-455.
11. Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, Reddy P, Parker W, Hoosain E, Naidoo P, Hongoro C, Mchiza Z, Steyn NP, Dwane N, Makoae M, Maluleke T, Ramlagan S, Zungu N, Evans MG, Jacobs L, Faber M, & SANHANES-1 Team (2013) South African National. National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: HSRC Press
12. National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research
![Page 42: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/42.jpg)
References12. Council (SAMRC), and ICF. 2019. South Africa Demographic and Health Survey 2016. Pretoria, South Africa,
and Rockville, Maryland, USA: NDoH, Stats SA, SAMRC, and ICF.
13. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019;1450(1):15-31. doi:10.1111/nyas.14092
14. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland: Author; 2011
15. Suchdev PS, Namaste SML, Aaron GJ, Raiten DJ, Brown KH, Flores-Ayala R. Overview of the biomarkers reflecting inflammation and nutritional determinants of anemia (BRINDA) project. Adv Nutr. 2016;7(2):349-356. doi:10.3945/an.115.010215
16. Muriuki JM, Mentzer AJ, Webb EL, et al. Estimating the burden of iron deficiency among African children. BMC Med. 2020;18(1):1-14. doi:10.1186/s12916-020-1502-7
17. Swart PDR, Rautenbach K, Raubenheimer JE. Reticulocyte haemoglobin content as a diagnostic tool for iron deficiency and iron-deficiency anaemia in ill infants and children. SAJCH South African J Child Heal. 2014;8(1):23-27. doi:10.7196/SAJCH.645
18. Palmeirim MS, Ame SM, Ali SM, Hattendorf J, Keiser J. Efficacy and Safety of a Single Dose versus a Multiple Dose Regimen of Mebendazole against Hookworm Infections in Children: A Randomised, Double-blind Trial. EClinicalMedicine. 2018;1:7-13. doi:10.1016/j.eclinm.2018.06.004
![Page 43: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/43.jpg)
References19. Helfaer MA, Carson BS, James CS, Gates J, Della-Lana D, Kolk C Vander. Increased hematocrit and
decreased transfusion requirements in children given erythropoietin before undergoing craniofacial surgery. J Neurosurg. 1998;88(4):704-708. doi:10.3171/jns.1998.88.4.0704
20. Meara JG, Smith EM, Harshbarger RJ, Farlo JN, Matar MM, Levy ML. Blood-conservation techniques in craniofacial surgery. Ann Plast Surg. 2005;54(5):525-529. doi:10.1097/01.sap.0000157901.57961.3b
21. Meneghini L, Zadra N, Aneloni V, Metrangolo S, Faggin R, Giusti F. Erythropoietin therapy and acute preoperative normovolaemic haemodilution in infants undergoing craniosynostosis surgery. Paediatr Anaesth. 2003;13(5):392-396. doi:10.1046/j.1460-9592.2003.01091.x
22. Krajewski K, Ashley RK, Pung N, et al. Successful blood conservation during craniosynostotic correction with dual therapy using procrit and cell saver. J Craniofac Surg. 2008;19(1):101-105. doi:10.1097/scs.0b013e3180f6112f
23. Vega RA, Lyon C, Kierce JF, Tye GW, Ritter AM, Rhodes JL. Minimizing transfusion requirements for children undergoing craniosynostosis repair: The CHoR protocol. Clinical article. J Neurosurg Pediatr. 2014;14(2):190-195. doi:10.3171/2014.4.PEDS13449
24. Escher PJ, Tu A, Kearney S, et al. Minimizing transfusion in sagittal craniosynostosis surgery: the Children’s Hospital of Minnesota Protocol. Child’s Nerv Syst. 2019;35(8):1357-1362. doi:10.1007/s00381-019-04157-5
![Page 44: Preoperative Anaemia in the Paediatric Patient: A South](https://reader031.vdocument.in/reader031/viewer/2022022804/621b1e18e982b2606c609a43/html5/thumbnails/44.jpg)
References25. Switzer T, Naraine N, Chamlati R, et al. Association between preoperative hemoglobin levels after iron
supplementation and perioperative blood transfusion requirements in children undergoing scoliosis surgery. Goobie S, ed. Pediatr Anesth. August 2020:pan.13987. doi:10.1111/pan.13987
26. Richards T, Baikady RR, Clevenger B, et al. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. Lancet. 2020;6736(20):1-9. doi:10.1016/S0140-6736(20)31539-7
27. ITACS trial (NCT02632760)