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array:24 [ "pii" => "S2387020622000754" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.07.012" "estado" => "S300" "fechaPublicacion" => "2022-03-11" "aid" => "5779" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2022;158:221-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775321004668" "issn" => "00257753" "doi" => "10.1016/j.medcli.2021.07.010" "estado" => "S300" "fechaPublicacion" => "2022-03-11" "aid" => "5779" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2022;158:221-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "Anemia en la enfermedad arterial periférica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "228" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Peripheral arterial disease and anaemia" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1933 "Ancho" => 2167 "Tamanyo" => 159863 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Análisis de la supervivencia según la hemoglobina preoperatoria.</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Curva superior: hemoglobina superior a 10<span class="elsevierStyleHsp" style=""></span>g/dl. Curva inferior: hemoglobina igual o inferior a 10<span class="elsevierStyleHsp" style=""></span>g/dl.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Reproducido de Esteban et al.<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">28</span></a>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Esteban, Inés Hernández-Rodríguez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Esteban" ] 1 => array:2 [ "nombre" => "Inés" "apellidos" => "Hernández-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020622000754" "doi" => "10.1016/j.medcle.2021.07.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622000754?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321004668?idApp=UINPBA00004N" "url" => "/00257753/0000015800000005/v1_202203010542/S0025775321004668/v1_202203010542/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020622000766" "issn" => "23870206" "doi" => "10.1016/j.medcle.2022.02.003" "estado" => "S300" "fechaPublicacion" => "2022-03-11" "aid" => "5822" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2022;158:229-32" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical report</span>" "titulo" => "Granulomatous mastitis associated with erythema nodosum: A case series of 42 patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "229" "paginaFinal" => "232" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mastitis granulomatosa asociada a eritema nudoso: estudio de 42 casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2011 "Ancho" => 1500 "Tamanyo" => 437335 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical presentation of some patients with granulomatous mastitis associated with erythema nodosum. A) Painful subcutaneous mass in the upper outer quadrant of the right breast and painful subcutaneous nodules (B) in the pretibial regions of the same patient's legs. C) Erythematous plaque with ulceration on the right breast and erythema nodosum (D) on the legs of the same case. E) Subcutaneous mass with erythematous plaque on the surface of the left breast and subcutaneous nodules (F) located in the pretibial regions and upper limbs.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Moreno-Vílchez, Clàudia Llobera-Ris, Rosa María Penin, María Jesús Pla, Francesca Mitjavila, Joaquim Marcoval" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Moreno-Vílchez" ] 1 => array:2 [ "nombre" => "Clàudia" "apellidos" => "Llobera-Ris" ] 2 => array:2 [ "nombre" => "Rosa María" "apellidos" => "Penin" ] 3 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Pla" ] 4 => array:2 [ "nombre" => "Francesca" "apellidos" => "Mitjavila" ] 5 => array:2 [ "nombre" => "Joaquim" "apellidos" => "Marcoval" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775321006060" "doi" => "10.1016/j.medcli.2021.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321006060?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622000766?idApp=UINPBA00004N" "url" => "/23870206/0000015800000005/v1_202203050916/S2387020622000766/v1_202203050916/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S238702062200078X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2022.02.004" "estado" => "S300" "fechaPublicacion" => "2022-03-11" "aid" => "5829" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2022;158:218-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "The human immunodeficiency virus infection 40 years later" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "218" "paginaFinal" => "220" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La infección por el virus de la inmunodeficiencia humana 40 años después" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José M. Miró" "autores" => array:1 [ 0 => array:2 [ "nombre" => "José M." "apellidos" => "Miró" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S002577532100628X" "doi" => "10.1016/j.medcli.2021.09.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577532100628X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062200078X?idApp=UINPBA00004N" "url" => "/23870206/0000015800000005/v1_202203050916/S238702062200078X/v1_202203050916/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Peripheral arterial disease and anaemia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "228" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Esteban, Inés Hernández-Rodríguez" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Carlos" "apellidos" => "Esteban" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Inés" "apellidos" => "Hernández-Rodríguez" "email" => array:1 [ 0 => "agnesrh@iconcologia.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Hematología, ICO-Hospital Universitari Germans Trias i Pujol, Institute de Investigación contra la Leucemia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Anemia en la enfermedad arterial periférica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1933 "Ancho" => 2167 "Tamanyo" => 160590 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Survival analysis according to preoperative haemoglobin.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Upper curve: haemoglobin greater than 10 g/dl Lower curve: haemoglobin equal to or lower than 10 g/dl</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Reproduced from Esteban et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A normal erythropoiesis requires a healthy bone marrow, as well as an adequate supply of nutrients (iron and vitamins C, B1, B6 and B12) and hormones (erythropoietin, steroids and thyroid hormones). A deficiency or imbalance in any of these elements will lead to the development of anaemia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Iron deficiency is by far the most common cause of anaemia, affecting more than 2 billion people worldwide.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It is associated with high prevalence with numerous chronic diseases, including most cancers (43%), inflammatory bowel diseases (45%), congestive heart failure (43–100%) and chronic renal failure (24–85%), among others.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A patient can develop iron deficiency progressively for different reasons: blood loss, insufficient iron supply (due to deficient diet or malabsorption), or increased iron needs (e.g., during pregnancy or some stages of growth). This iron deficiency can be translated into different pathological stages. For the surgical patient, the following classification has been proposed, according to ferritin levels and the calculation of the transferrin saturation index (TSI): (1) Inadequate iron storage for an intervention with expected moderate-severe haemorrhage: ferritin < 100 ng/ml; (2) absolute iron deficiency without anaemia: ferritin < 30 ng/ml; (3) iron deficiency anaemia: ferritin < 30 ng/ml with secondary anaemia; (4) functional iron deficiency: ferritin 100−500 ng/ml with IST < 20%; (5) iron blockade (concept overlapping with functional iron deficiency): ferritin > 100 ng/ml, with IST < 20% and/or C-reactive protein > 5 mg/l.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition to anaemia, iron deficiency can have a variety of manifestations, due to its role as a component of myoglobin, and in numerous cellular processes including mitochondrial respiration, gene regulation, cellular immunity, red-ox reactions, and so on.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> These manifestations include those typical of anaemia such as asthenia, adynamia, head instability, dyspnoea, tinnitus, skin-mucous pallor, etc. and those typical of functional iron deficiency, such as rhagades, restless legs syndrome, koilonychia, hair loss, pica, neuropsychological symptoms (somnolence, lack of concentration and loss of cognitive capacity, among others).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Deficiency of other nutrients such as folates or cobalamin is also a possible cause of anaemia, with a significantly lower prevalence compared to iron deficiency. However, this frequency increases with age (see section <span class="elsevierStyleItalic">anaemia in the surgical patient</span>).</p><p id="par0030" class="elsevierStylePara elsevierViewall">If no nutritional deficits are detected, other causes of anaemia should be ruled out, including inflammatory anaemia or anaemia due to kidney failure.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Inflammatory anaemia is caused by a complex mechanism mediated by hepcidin, a peptide of hepatic origin that negatively regulates iron absorption and its incorporation into plasma from stores in the reticulo-endothelial system. Several inflammatory cytokines produce an increase in hepcidin, inhibiting iron mobilization and, therefore, its incorporation into erythropoiesis (functional iron deficiency). Other effects also occur, such as downregulation of erythropoietin and increased erythrocyte senescence.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Numerous guidelines recommend investigating the cause of preoperative anaemia, postponing elective surgery if necessary; since delaying surgery is controversial, the main recommendation is to inform the patient of the risks of surgery with insufficiently treated or evaluated preoperative anaemia, and to offer the possibility of postponing surgery by 4 weeks for an appropriate approach to surgery. With regard to cancer surgery, anaemia can be addressed in patients receiving neoadjuvant therapy, as the treatment itself allows the intervention to be postponed.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,8–10</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Preoperative anaemia</span><p id="par0040" class="elsevierStylePara elsevierViewall">In a review of 3,342 patients who were candidates for major elective surgery (44.5% women), the prevalence of anaemia was 36.2% and 72% of cases were due to absolute or functional iron deficiency.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The prevalence of other nutritional deficiencies detected in the preoperative period of major orthopaedic surgery was 12% for B<span class="elsevierStyleInf">12</span> deficiency (<270 pg/ml) and 3% for folate deficiency (serum folate <3 ng/ml).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Low preoperative ferritin levels have been associated with a higher rate of postoperative infections in orthopaedic and abdominal surgery.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> Preoperative anaemia has been associated with a higher rate of transfusions, which is easily deductible, but also with higher rates of hospital stay, morbidity and mortality<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14–18</span></a> and these worsen with the severity of anemia.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Iron therapy, oral or intravenous, has resulted in a reduction in postoperative infections and postoperative mortality, as shown by the few observational studies available.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> However, quality evidence demonstrating that correction of preoperative anaemia improves postoperative complications in patients is lacking. In contrast, there is evidence that improvement in haemoglobin (Hb) with packed red cell transfusion may be detrimental to postoperative outcomes, including increased 30-day mortality and increased incidence of complications including infection, renal failure or cardiac complications.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20–22</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding treatment, there are clear proposals in the different guidelines regarding iron deficiency anaemia. If time allows, the general recommendation is to start with oral treatment. If 6 weeks or less are available before surgery, it is recommended to start intravenous iron at Hb- and weight-adjusted doses. It is also suggested that recombinant human erythropoietin be considered in cases of functional iron deficiency, usually as a single dose adjuvant to intravenous iron.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,8,10</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Anaemia in the patient with peripheral arterial disease</span><p id="par0055" class="elsevierStylePara elsevierViewall">According to the latest joint guidelines of the European Society of Cardiology and the European Society for Vascular Surgery, the term peripheral arterial disease (PAD) encompasses disease of all arteries except the coronary arteries and the aorta, and notes that a distinction should be made between this concept and the term peripheral arterial disease of the lower extremities (sometimes referred to as arteriopathy obliterans of the lower extremities), and specifies that other peripheral locations of arterial disease, such as the carotid artery, vertebral arteries, upper limb arteries, mesenteric and renal arteries that are frequently affected, especially by arteriosclerosis, are also part of the term PAD.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Candidates for arterial vascular surgery are usually elderly patients, with a high prevalence of preoperative anaemia (more than 50%), which is often multifactorial. This is a type of patient with an inflammatory state that accompanies chronic vascular disease. The prevalence of anaemia increases in patients over 75 years of age, or with high blood pressure, diabetes mellitus, heart disease, or kidney failure.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24–29</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Anaemia and allogeneic blood transfusion (matched donor blood transfusion) are independent risk factors for morbidity and mortality 30 days after arterial surgery. Also, an Hb lower than 10 g/dl is a risk factor for immediate and late mortality in patients undergoing vascular surgery.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30,31</span></a> An anaemia of 1 g/dl increases the risk of 30-day mortality by 4.2% in these patients.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,27,32</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">There are several risk scores that are used to assess the morbidity and mortality of patients who have to undergo interventional therapies in the field of peripheral artery disease. Recently, the ERICVA model has been developed as a risk score for amputation or death in patients with severe obliterative vascular disease of the lower limbs who undergo surgery. For this, a series of risk factors are analysed, such as the presence in the clinical history of diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, a history of previous vascular surgeries, etc. and a packed cell volume <30%. The authors demonstrate the usefulness of this score to predict the risk of mortality or major amputation at one year in patients who are operated on for critical lower limb ischemia. Of all the factors involved, the only one that is modifiable is the packed cell volume.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">PAD patients have a slightly different profile in terms of comorbidities and cardiovascular risk factors depending on the territory primarily affected and the severity of involvement. One such factor is anaemia, as documented in the literature. Thus, depending on the type of cohort studied, the prevalence of anaemia varies considerably. Patients with chronic lower limb ischemia who have to undergo surgery are those who have high degrees of critical ischemia in the Rutherford classification, which is the clinical grading of ischemia severity commonly used in the literature<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). In patients with critical ischaemia (Rutherford grades 4–6) the prevalence of anaemia is over 50% in all studies<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30,31,35</span></a>; in patients with intermittent claudication, it is approximately 10–15%,<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> in patients with aortic aneurysm it is 25–30%<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> and in those with carotid stenosis it is around 20%.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Moreover, anaemia in these patients is often accompanied by nutritional deficiencies.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29,39</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">When faced with the need for surgical intervention in patients with PAD, anaemia is of particular importance for several reasons. The main one is that surgeries on the arterial tree have a high probability of bleeding and of requiring transfusion in the perioperative period. These are usually urgent surgeries, which means that little time usually passes between the diagnosis and the intervention. This makes it impossible to correct anaemia before the intervention, as is the case in knee or hip surgery, an area in which anaemia has been shown to be a predictor of poor short- and long-term outcomes.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Peripheral arterial disease of the lower limbs</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Intermittent claudication</span><p id="par0085" class="elsevierStylePara elsevierViewall">Patients with intermittent claudication are in a less advanced stage of the disease and do not usually undergo any invasive procedure or surgical intervention. They have significant comorbidities, but there are virtually no publications assessing the possible effect of anaemia on their outcome.</p><p id="par0090" class="elsevierStylePara elsevierViewall">One study analyses the influence of anaemia on the occurrence of major cardiovascular events in a cohort of patients with peripheral arterial disease. These are data from the Risk Factors and Arterial Disease registry, which includes patients followed up in an outpatient clinic with symptomatic arterial disease and with at least one recent event (in the last 3 months) of PAD (claudication, vascular surgery, or amputation). With 1,663 cases monitored for 18 months (81% with intermittent claudication) they conclude that anaemia is associated with an increased risk of death, with a <span class="elsevierStyleItalic">hazard ratio</span> (HR) of 2.32, but not of myocardial infarction or amputation<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0095" class="elsevierStylePara elsevierViewall">There is another descriptive study that analyses the nutritional status of patients with PAD, which concludes that both anaemia and iron, vitamin B<span class="elsevierStyleInf">12</span> and folate deficiency are very prevalent, up to 62.1% of patients over the age of 75.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Severe or critical lower limb ischemia</span><p id="par0100" class="elsevierStylePara elsevierViewall">Critical ischemia is the most advanced stage of PAD and entails a non-negligible risk of suffering a major amputation if no revascularization intervention is performed. This is why almost all series studying patients at this stage discuss the results of surgical treatment.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The study by Toor et al.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> is the first published study with the primary endpoint of assessing the effect of preoperative anaemia in patients with critical ischaemia (Rutherford stage 4−5), who undergo endovascular revascularisation for the first time. As a primary endpoint, they define the occurrence of vascular events such as: need for revascularisation of the same lesion, amputation or death. They conclude (with a mean follow-up of 14 months) that moderate or severe preoperative anaemia is independently associated with higher mortality.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In a study designed in our hospital, with data from 12 centres and including 518 patients who underwent surgery for peripheral arterial disease, one in 5 had died at one year of follow-up. A preoperative Hb of 10 g/dl or less is related to higher mortality at one year and an increased probability of requiring amputation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). It was concluded that for every 1 g/dl increase in preoperative anaemia the risk of mortality decreases 0.8-fold.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The largest published series on patients hospitalised for PAD (Rutherford 1–6) consists of 41,882 individuals with a follow-up of 24 months. The objective was to evaluate the influence of anaemia of any type on short- and long-term complications. They show that during hospital stay anaemic patients have a 3–4 times higher amputation rate than non-anaemic patients and 4–6 times higher mortality. Furthermore, in the long term, chronic anaemia is a predictor of mortality and acute anaemia in the perioperative period is a predictor of amputation.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The results of the only prospective study with a one-year follow-up assessing the influence of anaemia on outcomes in patients hospitalised and operated on for PAD for the first time were published in 2014. This was a multicenter study, with 925 patients, with a prevalence of preoperative anaemia of 50.9%. The primary endpoint was to analyse the rate of major amputations and/or death. They demonstrated, both by survival analysis and multivariate analysis, that preoperative anaemia is associated with increased mortality (HR 1.47) and amputations (HR 1.47). In contrast to the previous work by Desormais et al., we found an HR almost 3 times lower because this series includes 55% of patients with lower degrees of ischemia. In addition, they also concluded that Hb levels are significantly and proportionally associated with a higher rate of major amputations at one year.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Short-term and long-term mortality were comprehensively analysed in a series of 403 consecutive patients who underwent surgery for critical ischaemia. They report a prevalence of anaemia of 75% in the sample. A preoperative Hb < 10 g/dl is associated with increased mortality at both 1 and 5 years in the survival analysis, and in the regression analysis they conclude that this level of Hb increases immediate mortality 3.9-fold and 2.5-fold at 5 years. This is a cohort of patients with very severe and advanced PAD that justifies both the prevalence of anaemia, which is one of the highest published, and the increase in mortality (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">A recent paper drawing its data from the <span class="elsevierStyleItalic">National Surgical Quality Improvement Program</span> (NSQIP) of the American College of Surgeons analysed 5,081 patients undergoing infrainguinal <span class="elsevierStyleItalic">bypass</span> for critical ischaemia. They report a prevalence of anaemia in the series of 70% and give results at 30 days, and as a primary endpoint they analyse mortality, major cardiovascular events and amputation. They conclude that moderate anaemia (packed cell volume 29–34) increases mortality 2.6-fold and cardiovascular events 1.9-fold, and that severe anaemia (packed cell volume < 29) increases the risk of death 2.8-fold and amputation 1.6-fold, among other factors. In addition, they do an analysis excluding patients who have been transfused perioperatively and find a 5.8-fold increase in mortality in non-transfused patients with severe anaemia.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Ambulgekar et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> used data from a registry of 15,681 patients who underwent endovascular and percutaneous surgery for severe PAD. As primary endpoints, they record any periprocedural adverse event, especially amputation, death, transfusions, contrast-induced renal failure or reintervention. With a prevalence of anaemia in the series of 42%, they conclude that anaemic patients have 2.5 times more adverse events in the perioperative period compared to non-anaemic patients. In addition, transfusions and amputations are 4.57 and 4.03 times more common and were not significant when analysing only major amputations. Patients in this study were selected according to intervention and the clinical severity of PAD or the percentage of patients with critical ischemia were not specified.</p><p id="par0140" class="elsevierStylePara elsevierViewall">A study with a very similar cohort of patients evaluated the impact of preoperative Hb in patients undergoing open or endovascular surgery for PAD, including carotid surgery.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> In addition, as a novelty, it evaluated the possible effect of the decrease in Hb at 30 days. The primary objective was to analyse major cardiovascular events and cardiovascular death. With 1,041 patients analysed, they concluded that preoperative anaemia is associated with an almost twofold increase in the risk of events (<span class="elsevierStyleItalic">odds ratio</span> [OR]: 1.7). But in addition, postoperative anaemia, both moderate (OR: 1.7) and severe (OR: 3.1), also has this negative association, and they finally confirmed that the decrease in Hb is also associated with an increased risk of events.</p><p id="par0145" class="elsevierStylePara elsevierViewall">As we can see, all the studies are either retrospective or are subsequent data analysis of prospective electronic records. No prospective study or clinical trial has been published evaluating the influence of anaemia on the outcomes of these patients.</p><p id="par0150" class="elsevierStylePara elsevierViewall">An observational, multicentre, prospective study has been designed in the United Kingdom to evaluate the effect of treatment of preoperative anaemia in patients undergoing cardiac or major vascular surgery (CAVIAR Study). It also aims to obtain information on the possibilities of establishing protocols for the management of preoperative anaemia and the design of future clinical trials in this field.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> The results of the patients participating in the study in the elective vascular surgery group, both open and endovascular, have recently been published. Of the total of the 142 patients analysed, 45% had anaemia. They found that anaemic patients have a higher transfusion rate and longer hospital stay than non-anaemic patients or those who are treated for preoperative anaemia. However, there are no differences between the groups in mortality, days of stay in the intensive care unit or readmissions.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Peripheral arterial disease in diabetics</span><p id="par0155" class="elsevierStylePara elsevierViewall">In patients with peripheral arterial disease, diabetes is 1.9–4 times more prevalent than in the general population.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> In addition, low Hb levels have been linked to the severity of diabetic foot.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">A series of 654 consecutive patients (between 2007 and 2012) with foot ulcers, 25% of whom have peripheral arterial disease, was retrospectively analysed in a referral centre for patients with diabetes. They found that, in addition to age, the presence of peripheral arterial disease and Hb < 11 were major amputation predictors and major amputation and Hb < 11 were predictors of mortality.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Carotid stenosis</span><p id="par0165" class="elsevierStylePara elsevierViewall">Only one study has been published that evaluates the impact of preoperative anaemia in patients with carotid stenosis. It compares data on postoperative mortality (30 days), rate of acute myocardial infarction and ipsilateral stroke. To do so, they used the NSQIP registry and studied 16,068 carotid thromboendarterectomies (TEAs) performed between 2011 and 2015. In asymptomatic TEAs they found no significant differences, but in TEAs due to symptomatic carotid stenosis they found that mortality and AMI rates were 2.7 and 2.0 times higher, respectively, in patients with preoperative anaemia in the multivariate analysis, and no differences were found in the rate of ipsilateral stroke. Furthermore, in terms of mortality they find that it increases proportionally to the decrease in preoperative Hb, and when analysing the effect of perioperative transfusions, they conclude that patients with preoperative anaemia have a higher mortality regardless of whether perioperative transfusions are received or not.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">Several papers have recently been published that focus on anaemia in patients with severe peripheral arterial disease who are operated on for different reasons. They are samples of large registries from routine or real-world practice. The great value of these articles lies in the huge number of patients they analyse and in the fact that they are “real” patients. In order to be able to study series of this size, the sample must necessarily be of this type. However, we believe that clinical trials provide essential information to be able to corroborate the results obtained from the analysis of these data-rich papers.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Preoperative anaemia related to major surgery has been clearly associated with a poor prognosis, in terms of increased risk of 30-day mortality, longer hospital stays, and higher number of complications.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,18</span></a> This review shows that preoperative Hb in patients with PAD is a factor that clearly influences surgical outcomes, together with other elements such as age, heart disease, renal failure, etc. Patients with peripheral arterial disease, especially those with advanced disease, tend to have low physiological reserves, in addition to cardiovascular disease (diagnosed or not), which translates into a high vulnerability in the event of small decreases in Hb.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">But whether correction of preoperative anaemia would improve patients’ clinical outcomes remains to be conclusively demonstrated, since of all the factors that seem to influence poor outcomes, anaemia is the only one that is potentially modifiable. For this, controlled and randomized clinical trials should be developed. Few have been carried out and at the moment none in the specific field of peripheral arterial disease or vascular surgery. However, evidence from other areas, such as heart failure or cardiac surgery, suggests that treatment of such anaemia would be beneficial in improving outcomes.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50,51</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Schack et al. performed a meta-analysis of the current scientific evidence on iron treatment of preoperative anaemia in acute surgery. They found 13 evaluable studies which demonstrated a significant reduction in the risk of transfusion, of which 4 were randomised and 9 were observational. Four of them showed a reduction in mortality and infection rates in the iron-treated group.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The CAVIAR study is the only prospective study conducted in patients with PAD undergoing major vascular surgery who have been treated for anaemia; it has only shown that intravenous iron increases postoperative Hb levels, but there is no difference in mortality or length of stay in the critical care unit. It should be noted that 142 patients were finally included, of whom only 15 were treated with intravenous iron. With such a low number of patients in the iron treatment arm, it is difficult to draw conclusions that can be generalized.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Pending further results or new studies, we have designed an approach to preoperative anaemia in our centre for patients who are candidates for elective vascular surgery (1−2 months until surgery), urgent deferrable (2−5 days until surgery) and urgent non-deferrable (1−2 days until surgery). The protocol aims to include a rapid and automated diagnosis through the application of expert analytical rules and depending on the type of anaemia it allows the selection of a treatment adjusted to its characteristics: it gives the option to supplement iron, vitamin B<span class="elsevierStyleInf">12</span> and folates, in addition to administering erythropoietin where necessary. All options are preset in the pharmacy software and only the appropriate one has to be selected (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusions</span><p id="par0200" class="elsevierStylePara elsevierViewall">Preoperative anaemia in patients with peripheral arterial disease is a predictor of poor prognosis. Specific protocols should be considered for these patients with the aim of modifying this deficit with a view to possibly improving postoperative outcomes. We propose a protocol adjusted to the type of anaemia in patients who are candidates for vascular surgery.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interests</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1675842" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1486882" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1675841" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1486881" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Preoperative anaemia" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Anaemia in the patient with peripheral arterial disease" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Peripheral arterial disease of the lower limbs" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Intermittent claudication" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Severe or critical lower limb ischemia" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Peripheral arterial disease in diabetics" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Carotid stenosis" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-03-24" "fechaAceptado" => "2021-07-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1486882" "palabras" => array:5 [ 0 => "Preoperative anaemia" 1 => "Peripheral artery disease" 2 => "Prognostic factors in vascular surgery" 3 => "Nutritional deficits" 4 => "Anaemia of inflammation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1486881" "palabras" => array:5 [ 0 => "Anemia preoperatoria" 1 => "Enfermedad arterial periférica" 2 => "Factores pronósticos en cirugía vascular" 3 => "Déficits nutricionales" 4 => "Anemia inflamatoria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Iron deficiency anaemia is highly prevalent worldwide. In the surgical patient, anaemia of any cause implies higher morbidity and mortality in the post-operative period. This is especially important in patients with peripheral artery disease, as they have very high rates of anemia due to iron deficiency or other causes. In intermittent claudication, anemia is a predictor of death in the medium term. Patients with critical ischemia have higher prevalence of anaemia and it is an indicator of amputation and death in the medium term. Specific protocols need to be developed for these patients since the natural history of their disease does not allow for the correction of anemia before surgery.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La anemia por déficit de hierro tiene una alta prevalencia en la población mundial. En el paciente quirúrgico la anemia de cualquier causa implica una mayor morbimortalidad en el postoperatorio. Esto es especialmente importante en el paciente con arteriopatía periférica, ya que tiene unas tasas muy elevadas de anemia por déficit de hierro o por otras causas. En la claudicación intermitente la anemia es factor predictor de muerte a medio plazo. En los pacientes con isquemia crítica en los que la prevalencia es más elevada es indicador de amputación y muerte a medio plazo. Es necesario elaborar protocolos específicos para estos pacientes ya que por la historia natural de su enfermedad no es posible corregir la anemia antes del acto quirúrgico.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Esteban C, Hernández-Rodríguez I. Anemia en la enfermedad arterial periférica. Med Clin (Barc). 2022;158:221–228.</p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2363 "Ancho" => 3137 "Tamanyo" => 338870 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Long-term survival in patients with chronic limb ischemia.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A: Long-term survival in patients with chronic limb ischemia undergoing revascularization, according to haemoglobin value (cut-off point: 10 g/dl). B: Long-term survival in patients with chronic limb ischemia undergoing endovascular revascularization, according to haemoglobin value (cut-off point: 10 g/dl). C: Long-term survival in patients with chronic limb ischemia undergoing open surgical revascularization, according to haemoglobin value (cut-off point: 10 g/dl).</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Reproduced from Velescu et al.,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> with the permission of the authors.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1933 "Ancho" => 2167 "Tamanyo" => 160590 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Survival analysis according to preoperative haemoglobin.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Upper curve: haemoglobin greater than 10 g/dl Lower curve: haemoglobin equal to or lower than 10 g/dl</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Reproduced from Esteban et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Follow-up (m): follow-up (months); RFAD: risk factors for arterial disease; PAD: peripheral arterial disease; ACS-NSQIP: <span class="elsevierStyleItalic">American College of Surgeons - National Surgical Quality Improvement Program</span>.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pathological group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Year-journal-author \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of study \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anaemia prevalence (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up (m) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inclusion criteria \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermittent claudication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2015 Angiology; Pérez et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.663 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RFAD registry (mild symptomatic PAD) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Critical ischemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009 J Vasc Surg; Toor et al.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">101 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consecutive patients with severe PAD (Rutherford 4−5) operated on for the first time \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2013 Eur J Anaesthesiol; Valentijn et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.041 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Undergoing open or endovascular surgery for aortoiliac disease, lower limb disease or carotid stenosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2014 Eur J Vasc Endovasc Surg; Desormais et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">925 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients hospitalized for the first time for severe PAD (Rutherford 3−6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2016 Eur J Vasc Endovasc Surg; Velescu et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">403 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients undergoing surgery for severe PAD (open or endovascular surgery) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2017 J Vasc Surg; Bodewes et al.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.081 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACS-NSQIP undergoing infrainguinal bypass surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2019 MedClin; Stephen et al.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">518 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients undergoing surgery for severe PAD (open or endovascular surgery) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carotid stenosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2018 J Vasc Surg; Pothof et al.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.068 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACS-NSQIP Registry; patients undergoing carotid endarterectomy \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2850815.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Main articles reviewed.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinic \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic (non-haemodynamically significant occlusive disease) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermittent claudication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild or long-distance intermittent claudication \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate or medium distance intermittent claudication \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe or short-distance intermittent claudication \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Critical or severe ischemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ischemic rest pain \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ulceration or gangrene with minor tissue loss \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ulceration or gangrene with major tissue loss \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2850814.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical categories of chronic lower limb ischemia according to Rutherford.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Automated actions generated in the laboratory computer system: women with haemoglobin < 12 g/dl: (a) if ferritin 30−100 ng/ml and fibrinogen > 4.5 g/l iron study is expanded (calculation of transferrin saturation index); and (b) if MCV > 96 fL: serum folate and vitamin B<span class="elsevierStyleInf">12</span> are expanded. Men with haemoglobin < 13 g/dl: (a) if ferritin 30−100 ng/ml and fibrinogen > 4.5 g/l, iron study is expanded (calculation of the transferrin saturation index); and (b) if MCV > 96 fL: serum folate and vitamin B are increased<span class="elsevierStyleInf">12</span>. The following comments are automatically created: follow iron deficiency anaemia protocol/follow inflammatory or mixed anaemia protocol/follow iron deficiency without anaemia protocol/follow cobalamin administration protocol.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Epo: epoetin, Hb: haemoglobin; IM: intramuscular route; IV: intravenous route; SC: subcutaneous route; PO: per os, orally.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elective surgery: 1–2 months until the intervention</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron deficiency anaemia protocol</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin ≥ 11 g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg IV + folic acid 5 mg/day PO until surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin 9.1–10.9 g/dl</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg IV + folic acid 5 mg/day PO until surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 500 mg IV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin ≤ 9 g/dl<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg IV + folic acid 5 mg/day PO until surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg IV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inflammatory or mixed anaemia protocol</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin ≥ 11 g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 500 mg IV + Epo alfa 40,000 IU SC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> + folic acid 5 mg/day PO until surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin 9.1–10.9 g/dl</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg IV + Epo alfa 40,000 IU SC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> + folic acid 5 mg/day PO until surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epo alpha 40,000 UI SC<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin ≤ 9 g/dl*</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg IV + Epo alfa 40,000 IU SC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> + folic acid 5 mg/day PO until surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Week -2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 500 mg IV + Epo alfa 40,000 IU SC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protocol for iron deficiency without anaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ferrous sulfate 105 mg PO until surgery</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cobalamin administration protocol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cyanocobalamin 1,000 μg IM weekly until surgery</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Deferrable urgent surgery: 2–5 days until surgery</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protocol for iron deficiency anaemia</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men Hb ≥ 12 g/dl or women Hb ≥ 11 g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 500 mg IV</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men Hb < 12 g/dl or women Hb < 11 g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[2.0]Inflammatory or mixed anaemia protocol</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men Hb ≥ 12 g/dl or women Hb ≥11 g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron sucrose 200 mg IV</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin 9.1–10.9 g/dL (women) or 11.9 (men) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 500 mg IV + Epo alfa 40,000 IU SC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin ≤ 9 g/dl<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg IV + Epo alfa 40,000 IU SC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protocol for iron deficiency without anaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 500 mg</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cobalamin administration protocol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cyanocobalamin 1,000 μg IM daily until surgery (a maximum of 5 days, then weekly)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urgent non-deferrable surgery: 1–2 days until surgery</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protocol for iron deficiency anaemia</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men Hb ≥ 12 g/dl or women Hb ≥ 11 g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 500 mg IV + folic acid 5 mg/day PO until surgery</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men Hb < 12 g/dl or women Hb < 11 g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg IV + folic acid 5 mg/day PO until surgery</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inflammatory or mixed anaemia protocol</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men Hb ≥12 g/dl or women Hb ≥ 11 g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron sucrose 200 mg IV + folic acid 5 mg/day PO until surgery</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin 9.1–10.9 g/dl (women) or 11.9 (men) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 500 mg IV + Epo alfa 40,000 IU SC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin  ≤ 9 g/dl<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 1,000 mg IV + Epo alfa 40,000 IU SC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protocol for iron deficiency without anaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iron carboxymaltose 500 mg</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cobalamin administration protocol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cyanocobalamin 1,000 μg IM daily until surgery (a maximum of 5 days, then weekly)</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2850816.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">If haemoglobin ≤8 g/dl is poorly tolerated, consider RBC transfusion and reassessment before surgery.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Assess the administration according to risk/benefit if there is a history of neoplasm.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Treatment protocol for preoperative anaemia in vascular surgery (Hospital Universitari Germans Trias i Pujol).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:51 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. McLean" 1 => "M. Cogswell" 2 => "I. Egli" 3 => "D. Wojdyla" 4 => "B. de Benoist" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S1368980008002401" "Revista" => array:5 [ "tituloSerie" => "Public Health Nutr" "fecha" => "2009" "volumen" => "12" "paginaInicial" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18498676" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Control of iron deficiency anemia in low- and middle-income countries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.-R. Pasricha" 1 => "H. Drakesmith" 2 => "J. Black" 3 => "D. Hipgrave" 4 => "B.-A. 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