The present study aimed to characterize the prevalence of anemia and iron deficiency in older Portuguese adults, and to compare it with the prevalence in younger individuals.

Anemia was more prevalent (P < 0.001) in participants aged ≥80 years (31.4%) compared with participants aged <65 years (19.6%) and 65–79 years (17.3%). At a 30-ng/mL ferritin cut-off, iron deficiency was more prevalent in participants aged ≥80 years (42.8%) compared with participants aged <65 years (31.5%) and 65–79 years (30.2%). Alternative ferritin cut-offs showed overall similar patterns. Anemia and iron deficiency were significantly more prevalent in older individuals who self-reported heart failure, coronary heart disease and gastritis. Anemia was more prevalent in participants aged <65 years in the north of Portugal and participants aged ≥65 years in central Portugal, following the prevalence of iron deficiency in the regions. In all regions, anemia was more prevalent in participants aged ≥80 years (reaching 39.0% in Lisbon and Tagus Valley, and 51.0% in the south).

Anemia and iron deficiency are highly prevalent in older Portuguese adults, particularly among those aged ≥80 years. Better diagnosis, prevention and treatment strategies should be implemented taking into account the outstanding role of iron deficiency in older Portuguese adults, the differences between regions and the intrinsic characteristics of this population.

Anaemia and iron deficiency are major public health problems with great implications on quality of life.

Aims

To establish the general prevalence of anaemia and iron deficiency in the adult Portuguese population and the prevalence by age, gender and region.

The measured prevalence of anaemia was 19.9% (95% confidence interval: 19.0–20.8%); 84% of cases were previously undiagnosed. Anaemia was more prevalent among women (20.8%), young adults (18−34 years) (22.8–30.5%), older adults (21.0%), and pregnant women (54.2%). Anaemia varied across regions: from 15.5% in the Center region to 24.9% in the South. Iron deficiency was also highly prevalent: 16.7% (ferritin <15 ng/mL), 31.9% (<30 ng/mL), 53.3% (<50 ng/mL) and 84.3% (<100 ng/mL). Iron deficiency anaemia represented most anaemia cases: 29.0% (ferritin <15 ng/mL), 54.8% (<30 ng/mL), 75.4% (<50 ng/mL) and 92.5% (<100 ng/mL).

Anaemia and iron deficiency are highly prevalent in Portugal and largely undiagnosed. Women, young adults and older individuals are more prone to present these conditions and there are marked regional asymmetries. Nationwide strategies for prevention, diagnosis and treatment of these conditions should be implemented.

Intravenous ferric carboxymaltose has been shown to improve symptoms and quality of life in patients with chronic heart failure and iron deficiency. We aimed to evaluate the effect of ferric carboxymaltose, compared with placebo, on outcomes in patients who were stabilised after an episode of acute heart failure.

In patients with iron deficiency, a left ventricular ejection fraction of less than 50%, and who were stabilised after an episode of acute heart failure, treatment with ferric carboxymaltose was safe and reduced the risk of heart failure hospitalisations, with no apparent effect on the risk of cardiovascular death.

Vigilance is essential in the perioperative period. When blood is not an option for the patient, especially in a procedure/surgery that normally holds a risk for blood transfusion, complexity is added to the management. Current technology and knowledge has made avoidance of blood transfusion a realistic option but it does require a concerted patient-centered effort from the perioperative team. In this article, we provide suggestions for a successful, safe, and bloodless journey for patients. The approaches include preoperative optimization as well as intraoperative and postoperative techniques to reduce blood loss, and also introduces current innovative substitutes for transfusions. This article also assists in considering and maneuvering through the legal and ethical systems to respect patients’ beliefs and ensuring their safety.

Therapy with i.v. iron in patients with chronic heart failure (CHF) and iron deficiency (ID) improves symptoms, functional
capacity, and quality of life. We sought to investigate whether these beneficial outcomes are independent of anaemia.

Treatment of ID with FCM in patients with CHF is equally efficacious and shows a similar favourable safety profile irrespective of anaemia. Iron status should be assessed in symptomatic CHF patients both with and without anaemia and treatment of ID should be considered.

Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the riskbenefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website. ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.

Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for management (including diagnosis, treatment, prevention and rehabilitation) of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk-benefit ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of the recommendation of particular management options were weighed and graded according to predefined scales.

Iron deficiency may impair aerobic performance. This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) would improve symptoms in patients who had heart failure, reduced left ventricular ejection fraction, and iron deficiency, either with or without anemia.

Treatment with intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency, with or without anemia, improves symptoms, functional capacity, and quality of life; the side-effect profile is acceptable. (ClinicalTrials.gov number, NCT00520780.)

The aim of this study was to assess the net clinical and prognostic effects of intravenous (i.v.) iron therapy in patients with systolic heart failure (HF) and iron deficiency (ID). We performed an aggregate data meta-analysis (random effects model) of randomized controlled trials that evaluated the effects of i.v. iron therapy in iron-deficient patients with systolic HF. We searched electronic databases up to September 2014. We identified five trials which fulfilled the inclusion criteria (509 patients received i.v. iron therapy in comparison with 342 controls). Intravenous iron therapy has been shown to reduce the risk of the combined endpoint of all-cause death or cardiovascular hospitalization [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.30–0.64, P < 0.0001], and the combined endpoint of cardiovascular death or hospitalization for worsening HF (OR 0.39, 95% CI 0.24–0.63, P = 0.0001). Intravenous iron therapy resulted in a reduction in NYHA class (data are reported as a mean net effect with 95% CIs for all continuous variables) (−0.54 class, 95% CI −0.87 to −0.21, P = 0.001); an increase in 6-min walking test distance (+31 m, 95% CI 18–43, P < 0.0001); and an improvement in quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ) score +5.5 points, 95% CI 2.8–8.3, P < 0.0001; European Quality of Life–5 Dimensions (EQ-5D) score +4.1 points, 95% CI 0.8–7.3, P = 0.01; Minnesota Living With Heart Failure Questionnaire (MLHFQ) score −19 points, 95% CI:–23 to −16, P < 0.0001; and Patient Global Assessment (PGA) +0.70 points, 95% CI 0.31–1.09, P = 0004]. The evidence indicates that i.v. iron therapy in iron-deficient patients with systolic HF improves outcomes, exercise capacity, and quality of life, and alleviates HF symptoms.

The aim of this study was to evaluate the benefits and safety of long-term i.v. iron therapy in iron-deficient patients with heart failure (HF).

Treatment of symptomatic, iron-deficient HF patients with FCM over a 1-year period resulted in sustainable improvement in functional capacity, symptoms, and QoL and may be associated with risk reduction of hospitalization for worsening HF (ClinicalTrials.gov number NCT01453608).

Erythropoiesis‐stimulating agents (ESAs) are commonly used to treat chemotherapy‐induced anemia (CIA). However, about half of patients do not benefit.

Our systematic review shows that addition of iron to ESAs offers superior hematopoietic response, reduces the risk of RBC transfusions, and improves Hb levels, and appears to be well tolerated. None of the included RCTs reported overall survival. We found no evidence for a difference in quality of life with iron supplementation.

Patient Blood Management (PBM) é um método seguro que visa melhorar a gestão médico-cirúrgica dos doentes de modo a que o seu próprio sangue seja conservado. Cerca de 32 a 60% dos doentes oncológicos têm deficiência de ferro, a maioria tem anemia e, por isso, é importante discutir estratégias que evitem o uso excessivo de sangue e redução da progressão de tumores e recor-rência do cancro. Neste artigo de posicionamento, um grupo de especialistas em conjunto com a Associação Portuguesa para o Estudo da Anemia (AWGP) discute o programa PBM em hematologia e oncologia tendo em conta diver-sos fatores que são atualmente utilizados para aprovar os tratamentos em uso, baseados nas últimas informações atualizadas das orientações internacionais do National Comprehensive Cancer Network® (NCCN).

Anaemia and iron deficiency (ID) are frequent complications in patients with solid tumours or haematological malignancies, particularly in patients treated with chemotherapeutic agents. Frequently, anaemia is associated with fatigue, impaired physical function and reduced quality of life (QoL). Consequences of anaemia may include impaired response to cancer treatment and reduced overall survival (OS), even though a causal direct relationship has not yet been established. These new ESMO Clinical Practice Guidelines provide tools to evaluate anaemia, also in patients with myelodysplastic syndromes (MDS), and include recommendations on how to safely manage chemotherapy-induced anaemia (CIA) with erythropoiesis-stimulating agents (ESAs), iron preparations for intravenous (i.v.) or oral administration, red blood cell (RBC) transfusions and combinations of these treatments. The major aims of anaemia management are the reduction or resolution of anaemia symptoms, particularly fatigue, and an improved QoL with the minimum invasive treatment that corrects the underlying causes and proves to be safe. Underlying causes of anaemia, mainly impaired erythropoietic activity and disturbed iron homeostasis, can be consequences of increased release of inflammatory cytokines due to the underlying cancer and/or toxicity of cancer therapy. Furthermore, vitamin B12 and folate deficiency are relatively rare causes of anaemia in cancer patients.

Anemia is prevalent in 30% to 90% of patients with cancer. Anemia can be corrected through treating the underlying cause or providing supportive care through either transfusion with packed red blood cells (PRBC) or administration of erythropoiesisstimulating agents (ESAs), with or without iron supplementation. Recent studies showing detrimental
health effects of ESAs sparked a series of FDA label revisions and a sea change in the perception of these once commonly used agents. In light of this, these guidelines underwent substantial revisions. The purpose of these guidelines is 2-fold: 1) to operationalize the evaluation and treatment of anemia in adult patients with cancer, with an emphasis on those with anemia who are receiving concomitant chemotherapy, and 2) to enable the patient and clinician to assess anemia treatment options based on individual patient conditions.
The pathophysiologic origins of anemia can be grouped into 3 categories: 1) decreased production of functional red blood cells (RBCs), 2) increased destruction of RBCs, and 3) blood loss. Hence, anemia is characterized by a decrease in hemoglobin (Hb) concentration, RBC count, or packed cell volume to subnormal levels.

A anemia tem etiologia multifatorial: patologias genéticas, deficiência da ingestão de micronutrientes (ferro, folato, vitamina B12) ou outras condições que induzem perda ou necessidade aumentada ou absorção diminuída dos mesmos (infeção aguda ou crónica, doença inflamatória intestinal, insuficiência cardíaca crónica, doença renal crónica, neoplasias, doenças autoimunes). A anemia na gravidez é definida por valores de hemoglobina (Hb) <11 g/dL e hematócrito (Hct) <33% no 1º e no 3º trimestres da gravidez; Hb <10,5 g/dL e Hct <32% no 2º trimestre, e Hb <10 g/dL no puerpério. A anemia constitui um problema global de saúde pública, afetando cerca de um quarto da população mundial. Em 2011, a OMS estimou uma prevalência de anemia gestacional de 38%, sendo de 26% na Europa. Em Portugal, um estudo prospetivo de 2016 refere uma prevalência de anemia na grávida de 2,5% (mas com uma prevalência de défice de ferro >38%), enquanto que o estudo EMPIRE descreveu uma prevalência de
anemia de 54,2% nas mulheres grávidas, com variações regionais. Assim, a SPOMMF recomenda que se realize o rastreio de anemia e ferropénia na gravidez, através do hemograma e da determinação da ferritina sérica.

Anaemia is a condition in which the number of red blood cells is insufficient to meet physiologic needs; it is caused by many conditions,particularly iron deficiency. Traditionally, daily iron supplementation has been a standard practice for preventing and treating anaemia.However, its long-term use has been limited, as it has been associated with adverse side effects such as nausea, constipation, and teethstaining. Intermittent iron supplementation has been suggested as an effective and safer alternative to daily iron supplementation forpreventing and reducing anaemia at the population level, especially in areas where this condition is highly prevalent.

We included 25 studies involving 10,996 women. Study methods were not well described in many of the included studies and thus assessingrisk of bias was difficult. The main limitations of the studies were lack of blinding and high attrition. Studies were mainly funded byinternational organisations, universities, and ministries of health within the countries. Approximately one third of the included studies didnot provide a funding source.

Intermittent iron supplementation may reduce anaemia and may improve iron stores among menstruating women in populations withdifferent anaemia and malaria backgrounds. In comparison with daily supplementation, the provision of iron supplements intermittentlyis probably as effective in preventing or controlling anaemia. More information is needed on morbidity (including malaria outcomes), sideeffects, work performance, economic productivity, depression, and adherence to the intervention. The quality of this evidence base rangedfrom very low to moderate quality, suggesting that we are uncertain about these effects.

Patient blood management (PBM) is the timely application of evidence-informed medical and surgical concepts designed tomaintain haemoglobin concentration, optimise haemostasis andminimise blood loss in an effort to improve patient outcomes. The aim of this consensus statement is to provide recommenda-tions on the management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period as part of PBM in obstetrics. A multidisciplinary panel of physicians with exper-tise in obstetrics, anaesthesia, haematology, policy making and epidemiology was convened by the Network for the Advance-ment of Patient Blood Management, Haemostasis and Thrombosis (NATA) in collaboration with the International Federationof Gynaecology and Obstetrics (FIGO) and the European Boardand College of Obstetrics and Gynaecology (EBCOG). Members of the task force assessed the quantity, quality and consistency of the published evidence and formulated recommendations using the system developed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. The recommendations in this consensus statement are intended for use by clinical practitioners managing the perinatalcare of women in all settings and by policy makers in charge of decision making for the update of clinical practice in health-care establishments. They need to be tailored for application in individual patients or any population after consideration of the values and preferences of both health-care providers and patients,as well as equity issues; explicit assessment of harms and benefits of each recommendation; feasibility including resources, capacity and equipment; and implementability.

Em 2001, a Sociedade Portuguesa de Ginecologia, por intermédio da sua Secção de Ginecologia Oncológica, promoveu o primeiro Consenso sobre Hemorragias Uterinas Anormais (HUA).
Em aplicação de conceitos que vigoravam à época, as hemorragias anormais com origem no corpo uterino classificavam-se em menorragia/hipermenorreia, metrorragia e menometrorragias.
O impacto da HUA é muito variável, podendo em fase aguda provocar disrupções severas com risco de vida para a mulher. Atendendo a que as situações que atinjam essa fase requerem da parte dos profissionais atuações rigorosas e concertadas considerou-se útil abordá-las em capítulo próprio.
Procurando fazer uma revisão temática exaustiva e abrangente, optou-se por incluir neste documento o tratamento da anemia ferropénica, inevitavelmente ligada a quadros clínicos de hemorragia e que muitas vezes é negligenciada.
Os consensos registados no presente documento foram obtidos com base numa ampla pesquisa bibliográfica, permitindo estabelecer níveis de evidência e graduações em relação a cada recomendação aplicando o sistema GRADE.
Os consensos obtidos deverão ser vistos como instrumentos de reflexão para os profissionais que se confrontam com casos dessa natureza proporcionando informação utilizável no exercício da sua prática clínica, designadamente, nas fases de diagnóstico e da escolha da terapêutica a adotar na HUA.

Iron deficiency anaemia (IDA) occurs in 2-5% of adult men and postmenopausal women in the developed world and is a common cause of referral to gastroenterologists. Gastrointestinal (GI) blood loss from colonic cancer or gastric cancer, and malabsorption in coeliac disease are the most important causes that need to be sought.

These guidelines are primarily intended for Western gastroenterologists and gastrointestinal (GI) surgeons, but are applicable for other doctors seeing patients with iron deficiency anaemia (IDA). They are not designed to cover patients with overt blood loss or those who present with GI symptoms. GI symptoms or patients at particular risk of GI disease should be investigated on their own merits.

Anaemia is the most common systemic complication and extraintestinal manifestation of inflammatory bowel disease [IBD]. In the majority of cases, IBD-associated anaemia is a unique example of the combination of chronic iron deficiency and anaemia of chronic disease [ACD]. Other more rare causes of anaemia in IBD include vitamin B12 and
folate deficiency, toxic effects of medications, and others. The impact of anaemia on the quality of life of IBD patients is substantial. It affects various aspects of quality of life such as physical, emotional, and cognitive functions, the ability to work, hospitalization, and healthcare costs. Anaemia in IBD is not just a laboratory marker; it is a complication of IBD that needs appropriate diagnostic and therapeutic approaches.

Despite the broad use of anti-inflammatory therapy, anaemia may recur fast after successful therapy. As anaemia is a serious medical condition that may become life threatening [if blood transfusions are not available or compatible], preventive measures should be considered. Prevention of anaemia and maintenance of iron and vitamin stores are therefore warranted.

Anemia is considered a public health issue and is often caused by iron deficiency. Iron-deficiency anemia (IDA) often originates from blood loss from lesions in the gastrointestinal tract in men and postmenopausal women, and its prevalence among patients with gastrointestinal bleeding has been estimated to be 61%. However, few guidelines regarding the appropriate investigation of patients with IDA due to gastrointestinal bleeding have been published.

These recommendations may serve as a starting point for clinicians to better diagnose and treat IDA in patients with gastrointestinal bleeding, which ultimately may improve health outcomes in these patients.

Anaemia is a commonly diagnosed complication among patients suffering with chronic kidney disease. If left untreated, it may affect patient quality of life. There are several causes for anaemia in this patient population. As the kidney function deteriorates, together with medications and dietary restrictions, patients may develop iron deficiency, resulting in reduction of iron supply to the bone marrow (which is the body organ responsible for the production of different blood elements). Chronic kidney disease patients may not be able to utilise their own body’s iron stores effectively and hence, many patients, particularly those receiving haemodialysis, may require additional iron treatment, usually provided by infusion.
With further weakening of kidney function, patients with chronic kidney disease may need additional treatment with a substance called erythropoietin which drives the bone marrow to produce its own blood. This substance, which is naturally produced by the kidneys, becomes relatively deficient in patients with chronic kidney disease. Any patients will eventually require treatment with erythropoietin or similar products that are given by injection.
Over the last few years, several iron and erythropoietin products have been licensed for treating anaemia in chronic kidney disease patients. In addition, several publications discussed the benefits of each treatment and possible risks associated with long term treatment. The current guidelines provide advice to health care professionals on how to screen chronic kidney disease patients for anaemia, which patients to investigate for other causes of anaemia, when
and how to treat patients with different medications, how to ensure safe prescribing of treatment and how to diagnose and manage complications associated with anaemia and the drugs used for its treatment.

This Clinical Practice Guideline document is based upon systematic literature searches last conducted in October 2010, supplemented with additional evidence through March 2012. It is designed to provide information and assist decision making. It is not intended to define a standard of care, and should not be construed as one, nor should it be interpreted as prescribing an exclusive course of management. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every health-care professional making use of these recommendations is responsible for evaluating the appropriateness of applying them in any particular clinical situation. The recommendations for research contained within this document are general and do not imply a specific protocol.

Kidney Disease: Improving Global Outcomes (KDIGO) makes every effort to avoid any actual or reasonably perceived conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the Work Group. All members of the Work Group are required to complete, sign, and submit a disclosure and attestation form showing all such relationships that might be perceived or actual conflicts of interest. This document is updated annually and information is adjusted accordingly. All reported information will be printed in the final publication and are on file at the National Kidney Foundation (NKF), Managing Agent for KDIGO.

Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD), both in pediatric and in adult patients. Iron deficiency is the main cause of anemia in patients with IBD. Anemia is a clinically relevant comorbidity,
with impact on patients’ quality of life and it should be timely diagnosed and adequately treated. Currently, an active
treatment approach is the recommended strategy, with evidence showing efficacy and safety of intravenous iron formulations. However, evidence in pediatric age remains scarce and no clinical recommendations exist for the diagnosis and treatment of this particular age group. The present document represents the first national consensus on the management of anemia in pediatric IBD and is therefore particularly relevant. The authors anticipate that the proposed recommendations will be useful in daily clinical practice for diagnosing and managing iron deficiency and iron-deficiency anemia in the pediatric population with IBD.

Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical
patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient’s target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for
nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcomes.

In cardiac surgical patients it is a complex challenge to find the ideal balance between anticoagulation and hemostasis. Preoperative anemia and perioperative higher transfusion rates are related to increased morbidity and mortality. Patient blood management (PBM) is an evidence based patient specific individualized protocol used in the perioperative setting in order to reduce perioperative bleeding and transfusion rates and to improve patient outcomes. The three pillars of PBM in cardiac surgery consist of optimization of preoperative erythropoiesis and hemostasis, minimizing blood loss, and improving patient specific physiological reserves. This narrative review focuses on the challenges with special emphasis on PBM in the preoperative phase and intraoperative transfusion management and hemostasis in cardiac surgery patients. It is a “must” that PBM is a collaborative effort between anesthesiologists, surgeons, perfusionists, intensivists and transfusion laboratory teams. This review represents an up to date overview over “PBM in cardiac surgery patients”.

A cirurgia eletiva é aquela que não se reveste das características de urgência ou emergência, ou seja, quando o doente não está sob o risco de vida, podendo ser efetuada em data programada, desde que essa data não comprometa a eficácia da intervenção.
O conceito de “gestão do sangue do doente” (Patient Blood Management: PBM) corresponde a uma estratégia global de boas práticas de transfusão, que permite a melhor utilização do sangue e dos seus componentes. O PBM é um exemplo de medicina baseada na evidência centrada no doente que, otimizando e conservando o próprio sangue do doente, visa melhorar os seus resultados em saúde.
Existem Recomendações Europeias, publicadas em março de 2017, dirigidas aos Hospitais e Autoridades Nacionais de Saúde, que recomendam o PBM como estratégia a implementar.

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 own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the peri-operative period. These statements include: a diagnostic approach for anaemia and iron deficiency in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up. We urge anaesthetists and peri-operative physicians to embrace these recommendations, and hospital administrators to enable implementation of these concepts by allocating adequate resources.

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 presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the postoperative period. These statements include: a diagnostic approach to iron deficiency and anaemia in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up that is easy to implement. Available data allow the fulfilment of the requirements of Pillar 1 of Patient Blood Management. We urge national and international research funding bodies to take note of these recommendations, particularly in terms of funding large-scale prospective, randomised clinical trials that can most effectively address the important clinical questions and this clearly unmet medical need.

The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work. pré-operatórios

AA presente Norma aborda o diagnóstico e tratamento das deficiências de ferro no adulto. Considera-se como adulto os maiores ou iguais a 18 anos.

A anemia por deficiência de ferro, constitui a deficiência mais prevalente no mundo segundo a OMS que define anemia se: 1) Hemoglobina <13g/dl no homem e <12g/dl na mulher.

A deficiência de ferro vai desde o estado de depleção de ferro sem anemia à anemia ferropénica.