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Leading the way in experimental and clinical research in hematology

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Marco Scardino , Tiziana D'Amato , Federica Martorelli , Giorgia Fenocchio , Elena Pera and Germano Tarantino
Blood 2017 130:3352;
Marco Scardino
Hip and Prosthetic Orthopedics OU, Humanitas Research Hospital, Rozzano, Italy
Tiziana D'Amato
Hip and Prosthetic Orthopedics OU, Humanitas Research Hospital, Rozzano, Italy
Federica Martorelli
Hip and Prosthetic Orthopedics OU, Humanitas Research Hospital, Rozzano, Italy
Giorgia Fenocchio
Hip and Prosthetic Orthopedics OU, Humanitas Research Hospital, Rozzano, Italy
Elena Pera
Pharmanutra S.p.A., Pisa, ITA
Germano Tarantino
Pharmanutra S.p.A., Pisa, ITA

Low peri-operative hemoglobin (Hb) values in orthopedic surgery patients are associated to a longer hospital stay, higher red blood cells transfusion (RBCT) rates and mortality. Compared to non-anaemic patients, anaemic patients have a 42% higher risk of mortality and a 35% higher risk of serious complications [1]. Timely prevention of peri-operative anemia and iron stores can improve patient outcome and reduce RBCT requirements, since pre-operative anaemia appears to be also related to poor prognosis. Sucrosomial® iron (Sideral® Forte, PharmaNutra) is a formulation where iron is covered by phospholipids plus sucrose esters of fatty acids matrix, allowing a higher absorption of iron compared to ferrous sulfate and avoiding typical gastrointestinal side effects. Sucrosomial® iron appears to have high tolerability and to be effective in improving the patient's anaemic condition in terms of serum iron, Hb and ferritin, which have been confirmed by several studies, even in comparison with IV iron treatment, showing similar results [2, 3, 4, 5]. Thus, for these reasons, the efficacy of sucrosomial® iron supplementation in prosthetic hip surgery patients was assessed in terms of Hb levels, length of hospital stay (LOS) and RBCT.

The study was conducted between 2015 and February 2017 on patients undergoing prosthetic hip surgery. The period taken into consideration was a follow-up period after the implementation of the pre-operative protocol, which was gradually implemented from 2011 to 2014 with the introduction of sucrosomial® iron. The protocol includes a full blood count, including CRP and ferritin, 21-28 days prior to surgery during the pre-operative visit. In case of a ferritin level <100 mcg/L and/or Hb level <14 g/dL for male and 13 g/dL for female, sucrosomial® iron is prescribed at a dosage of 1 cps/day corresponding to 30mg of elemental iron, for 21-28 days before and 7-10 days after surgery.

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Although water passes easily through the membrane, it is not removed by dialysis because its concentration in the blood is lower than in the solution; indeed, water tends to pass from the solution into the blood. The dilution of the blood that would result from this process is prevented by ultrafiltration , by which some of the water, along with some dissolved materials, is forced through the membrane by maintaining the blood at a higher pressure than the solution.

The membranes first used in dialysis were obtained from animals or prepared from collodion; cellophane has been found to be more suitable, and tubes or sheets of it are used in many dialyzers. In the late 1960s hollow filaments of cellulosic or synthetic materials were introduced for dialysis; bundles of such filaments provide a large membrane surface in a small volume, a combination advantageous in devising compact dialyzers.

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or from poisoning by diffusible substances, such as aspirin, bromides, or barbiturates. Blood is diverted from an artery, usually one in the wrist, into the dialyzer, where it flows—either by its own impetus or with the aid of a mechanical pump—along one surface of the membrane. Finally the blood passes through a trap that removes clots and bubbles and returns to a vein in the patient’s forearm. In persons with chronic kidney failure, who require frequent dialysis, repeated surgical access to the blood vessels used in the treatments is obviated by provision of an external plastic shunt between them.

Learn More in these related Britannica articles:

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uremia
…cases, treatment typically is with dialysis—i.e., the artificial filtering of the blood by a machine outside the body.…
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