Manuel Muñoz

University of Malaga | UMA · Transfusion Medicine

Background: Perioperative anemia has been associated with increased risk of red blood cell transfusion and increased morbidity and mortality following surgery. The optimal approach to the diagnosis and management of perioperative anemia is not fully established. Objective: To develop consensus recommendations for anemia management in surgical pa...

Background: Recent clinical guidelines suggest that treatment of postoperative anaemia in colorectal cancer surgery with intravenous iron reduces transfusion requirements and improves outcomes. The study aimed at comparing two intravenous iron regimens in anaemic patients after colorectal cancer surgery. Materials and methods: This was a single-...

Background Over the last decade, preoperative anemia has become recognized as a clinical condition in need of management. Although the etiology of preoperative anemia can be multifactorial, two-thirds of anemic elective surgical patients have iron deficiency anemia. At the same time, one-third of non-anemic elective surgical patients are also iron...

Patient blood management is a highly successful and cost-effective concept that improves patient outcome by correction of anemia with hematinic medication and reduction of blood loss perioperatively by meticulous surgical techniques and individualized coagulation management.

Introduction . Massive hemorrhage continues to be a treatable cause of death. Its management varies from prefixed ratio-driven administration of blood components to goal-directed therapy based on point-of-care testing and administration of coagulation factor concentrates. Areas covered . We review the current role of fibrinogen concentrate (FC) fo...

Aumenta la tendencia de alimentos que colorean El color es uno de los atributos más importantes en los alimentos y se considera un indicador de calidad y de aceptabilidad, así para la mayoría de los consumidores una bebida, una jalea o un caramelo con un color atractivo es más demandado. Sin embargo, los colorantes sintéticos ampliamente usados en...

Background: Preoperative anaemia is highly prevalent among patients scheduled for total hip arthroplasty (THA), and is the main risk factor for perioperative red blood cell transfusion (RBCT). This retrospective cohort study aimed at assessing whether preoperative haemoglobin (Hb) optimisation reduced RBCT rates and improved outcome in this patien...

Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-va...

As COVID‐19 disease escalates globally, optimising patient outcome during this catastrophic health care crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinician...

The World Health Organization (WHO) has declared Coronavirus Disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. Global health care now faces unprecedented challenges with widespread and rapid human-to-human transmission of SARS-CoV-2 and high morbidity and mortality with COVI...

Patient blood management is a highly successful and cost-effective concept that improves patient outcome by correction of anemia with hematinic medication and reduction of blood loss perioperatively by meticulous surgical techniques and individualized coagulation management.

The current agricultural water panorama in many Mediterranean countries is composed by desalination facilities, wells (frequently overexploited), the water public utility network, and several consumer agents with different water needs. This distributed water network requires centralized management methods for its proper use, which are difficult to...

This prospective study aimed at investigating the influence of surgery type and perioperative sampling times on the correlations between rotational thromboelastometry (ROTEM) parameters and standard laboratory coagulation tests assessing comparable coagulation phases. Patients undergoing glioblastoma multiforme resection (GBR group, n = 60) or lapa...

In major elective surgery, patient may be exposed to the effects of pre-operative anemia, blood loss and red cell transfusion, all of which may adversely influence post-operative rates of morbidity, mortality and readmission, and length of hospital stay. Preoperative anemia is prevalent among patients scheduled for major surgery (30-40%), while pos...

Preoperative anemia affects 30–40% of patients undergoing major surgery and is an independent risk factor for perioperative blood transfusion, morbidity, and mortality. Absolute or functional iron deficiency is its leading cause. Nonanemic hematinic deficiencies are also prevalent and may hamper preoperative hemoglobin optimization and/or recovery...

IV iron is indicated in clinical conditions, where rapid anaemia alleviation and repletion of iron stores are required. The acute toxicity of IV iron is ascribed to the presence of labile iron in plasma. Thus, shorter plasma residence time might improve the safety profile, even for compounds holding‐on the iron tightly. In this single‐centre, open‐...

Patient blood management (PBM) is the timely application of evidence-informed medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis, and minimise blood loss in an effort to improve patient outcomes. The aim of this consensus statement is to provide recommendations on the prevention and treatment of postp...

El Patient Blood Management (PBM) se define como "la aplicación pertinente de conceptos médicos y quirúrgicos basados en la mejor evidencia y diseñados para mantener la concentración de hemoglobina, optimizar la hemostasia y reducir al mínimo la pérdida de sangre en un esfuerzo por mejorar los resultados clínicos del paciente". Constituye un nuevo...

Absolute or functional iron deficiency is the most prevalent cause of anaemia in surgical patients, and its correction is a fundamental strategy within "Patient Blood Management" programmes. Offering perioperative oral iron for treating iron deficiency anaemia is still recommended, but intravenous iron has been demonstrated to be superior in most c...

Iron deficiency (ID) is usually treated with oral iron salts, but up to 50% of patients complain of gastrointestinal side effects, leading to reduced treatment compliance. Intravenous (IV) iron formulations are increasingly safer, but there is still a risk of infusion and hypersensitivity reactions and the need for a venous access and infusion moni...

: The current prospective study was aimed at investigating whether a portable coagulometer (qLabs) can be used to reliably monitor activated thromboplastin time (aPTT) and international normalized ratio (INR) in critically ill patients, as compared with standard central laboratory measurement. Both precision and accuracy of INR and aPTT measured by...

Background: Total hip arthroplasty entails considerable peri-operative blood loss, which may lead to acute post-operative anaemia and red blood cell transfusion. This study was aimed at assessing whether the addition of topical tranexamic acid to our ongoing blood-saving protocol for total hip arthroplasty was effective and safe. Materials and me...

Despite numerous guidelines on the management of anaemia in surgical patients, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in the postoperative period. A number of experienced researchers and clinicians took part in a two‐day expert workshop and developed the following consensus statement. After pr...

Introduction. Iron deficiency (ID), with or without anemia, is highly prevalent worldwide and has clinical consequences. The prevention and treatment of ID is a major public health goal. Accurate diagnosis, selection of the appropriate iron replacement therapy and addressing the underlying cause, remain as the main challenges in ID management. Area...

Anaemia is common in the elderly and is associated with an increased risk of physical, functional, and cognitive impairment, hospitalization and mortality. Although it is unknown whether anaemia is a causal factor or a subrogated marker of worse health status, its correction can improve the patients’ physical and functional capacity. Detection, cla...

The prevention and treatment of iron deficiency is a major public health goal. Challenges in the treatment of iron deficiency include finding and addressing the underlying cause and the selection of an iron replacement product which meets the needs of the patient. However, there are a number of non-evidence-based misconceptions regarding the diagno...

Background: Preoperative anemia prevalence among colorectal cancer (CRC) patients is high and may adversely influence postoperative outcome. This study assesses the efficacy of a preoperative anemia managing protocol in CRC. Study design and methods: This was a retrospective analysis of consecutive CRC resections at two Spanish centers (January...

The issue of the most appropriate red blood cell transfusion policy has been addressed by a number of randomised controlled trials, conducted over the last decades, comparing the effects on patients' outcome of restrictive blood transfusion strategies (transfusing when the haemoglobin concentration is less than 7 g/dL to 8 g/dL) vs more liberal one...

Anaemia is common in the elderly and is associated with an increased risk of physical, functional, and cognitive impairment, hospitalisation and mortality. Although it is unknown whether anaemia is a causal factor or a subrogated marker of worse health status, its correction can improve the patients' physical and functional capacity. Detection, cla...

Introduction: Disorders of iron metabolism are commonly seen in onco-hematological clinical practice. Iron-deficiency anemia and cancer-associated anemia are usually treated with supportive therapies. Optimal management of these conditions are discussed in this perspective paper. Areas covered: A position paper discussing a number of hot topics on...

In neurocritically ill patients (NCPs), the use of hemoglobin level as the sole indicator for red blood cell transfusion (RBCT) can result in under- or over-transfusion. This randomised controlled trial was conducted to ascertain whether a transcranial oxygen saturation (rSO2) threshold, as measured by near-infrared spectroscopy, reduces RBCT requi...

Pre-operative anaemia in patients undergoing major surgical procedures has been linked to poor outcomes. Therefore, early detection and treatment of pre-operative anaemia is recommended. However, to effectively implement a pre-operative anaemia management protocol, an estimation of its prevalence and main causes is needed. We analysed data from 334...

Background More than 30% of the world’s population are anemic with serious medical and economic consequences. Red blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient blood management (PBM) is a patient-centered and multidisciplinary approa...

Background: A fast-track anaemia clinic (FTAC) for the management of moderate-to-severe iron-deficiency anaemia (IDA) was established in our Emergency Department in 2010. In this FTAC, the replacement of packed red cell transfusion by ferric carboxymaltose administration was proven to be safe and effective. The aim of this study was a cost-analysi...

Over 30% of the world's population. are anaemic with serious economic consequences including reduced work capacity and other obstacles to national welfare and development. Red blood cell (RBC) transfusion is the mainstay to correct anaemia, but it is also one of the top five overused procedures within the Choosing Wisely Initiative. Patient Blood M...

Despite current recommendations on the management of pre-operative anaemia, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in surgical patients. A number of experienced researchers and clinicians took part in an expert workshop and developed the following consensus statement. After presentation of our...

Background: Transfusion of blood components continues to be an important therapeutic resource into the 21(st) century. Between 5 and 58% of transfusions carried out are estimated to be unnecessary. According to several studies, at least 20% of packed red blood cell transfusions (RBCT) are administered in hospital emergency departments (ED), but fe...

Objective: To audit the impact upon mortality of a massive bleeding management protocol (MBP) implemented in our center since 2007. Design: A retrospective, single-center study was carried out. Patients transfused after MBP implementation (2007-2012, Group 2) were compared with a historical cohort (2005-2006, Group 1). Background: Massive blee...

Over 30% of the world's population are anaemic with serious economic consequences including reduced work capacity and other obstacles to national welfare and development. Red blood cell (RBC) transfusion is the mainstay to correct anaemia, but it is also one of the top five overused procedures. Patient Blood Management (PBM) is a proactive, patient...

Peri-operative anaemia, blood loss and allogeneic blood transfusion are associated with increased postoperative morbidity and mortality, and prolonged hospital stay. A multidisciplinary, multimodal, individualised strategy, collectively termed ‘patient blood management’, may reduce or eliminate allogeneic blood transfusion and improve outcomes. Thi...

This book gathers together the collected wisdom of an experienced group of practitioners from the world of blood conservation including surgeons, anaesthetists, haematologists, transfusion specialists, microbiologists, and legal advisors. Topics included are: an historical overview, transfusion-transmitted diseases, changing demographics and the p...

Background: Clinically significant anaemia, requiring red blood cell transfusions, is frequently observed in Emergency Departments (ED). To optimise blood product use, we developed a clinical protocol for the management of iron-deficiency anaemia in a fast-track anaemia clinic within the ED. Materials and methods: From November 2010 to January 2...

Background: This 3-year prospective study examined the association between red blood cell transfusion (RBCT) and 1-year neurocognitive and disability levels in 309 patients with traumatic brain injury (TBI) admitted to the neurological intensive care unit (NICU). Methods: Using a telephone interview-based survey, functional outcomes were assesse...

In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplin...

In major surgery, the implementation of multidisciplinary, multimodal and individualized strategies, collectively termed Patient Blood Management, aims to identify modifiable risks and optimise patients' own physiology with the ultimate goal of improving outcomes. Among the various strategies utilized in Patient Blood Management, timely detection a...

Orthopedic and trauma surgical procedures (OTS) can lead to significant blood losses and acute postoperative anemia, which in many cases requires allogeneic blood transfusions (ABT). The clinical, economic and logistical disadvantages of ABT have promoted the development of multidisciplinary and multimodal programs generically known as Patient Bloo...

Prevalence of pre-operative anaemia A recent study, using public data from 187 countries worldwide and World Health Organization (WHO) definitions of anaemia (Table I), found a significant decrement in the global prevalence of anaemia, which decreased from 40.2% in 1990 to 32.9% in 2010, though the prevalence varied widely across regions 1. However...

Anemia is one of the world's most common disorders. In 2010, global anemia prevalence was 32.9%, affecting over 2.2 billion people, and iron deficiency the most common of the causes. 1 Oral iron, while inexpensive and effective when taken and tolerated, is frequently associated with unpleasant gastrointestinal side-effects, resulting in high rates...

Orthopaedic and trauma surgical procedures (OTS) can lead to significant blood losses and acute postoperative anaemia, which in many cases requires allogeneic blood transfusions (ABT). The clinical, economic and logistical disadvantages of ABT have promoted the development of multidisciplinary and multimodal programs generically known as Patient Bl...

This retrospective, single centre study was conducted to investigate the efficacy of fibrinogen concentrate (FBNc) in decreasing blood requirements and reaching optimal fibrinogen level, in non-trauma, massively transfused, bleeding patients with coagulopathy. Over a 3-years period, all patients for whom a massive transfusion protocol was activated...

In patients undergoing major surgical procedures, preoperative anaemia and perioperative allogeneic blood transfusion (ABT) have been linked to increased postoperative morbidity and mortality, as well as longer hospital stays. A multidisciplinary, multimodal, individualised strategy – collectively termed patient blood management – used to minimise...