***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To evaluate the safety and efficacy of intravenous ( IV ) sodium ferric gluconate complex ( FG ) , oral ferrous sulfate , or no iron to increase hemoglobin ( Hb ) in anemic cancer patients receiving chemotherapy and epoetin alfa .  PATIENTS AND METHODS In this open-label , multicenter trial , 187 patients with chemotherapy-related anemia ( Hb < 11 g/dl ; serum ferritin > or = 100 ng/ml or transferrin saturation > or = 15 % ) scheduled to receive chemotherapy and epoetin alfa ( 40,000 U subcutaneously weekly ) were r and omized to 8 weeks of 125 mg of IV FG weekly , 325 mg of oral ferrous sulfate three times daily , or no iron . The primary outcome was a change in Hb from baseline to endpoint , first whole-blood or red blood cell transfusion , or study withdrawal . RESULTS One hundred twenty-nine patients were evaluable for efficacy ( FG , n = 41 ; oral iron , n = 44 ; no iron , n = 44 ) . Mean increase in Hb was 2.4 g/dl ( 95 % confidence interval [ CI ] , 2.1 - 2.7 ) for FG ( p = .0092 vs. oral iron ; p = .0044 vs. no iron ) , 1.6 g/dl ( 95 % CI , 1.1 - 2.1 ) for oral iron ( p = .7695 vs. no iron ) , and 1.5 g/dl ( 95 % CI , 1.1 - 1.9 ) for no iron . Hb response ( increase > or = 2 g/dl ) was 73 % for FG ( p = .0099 vs. oral iron ; p = .0029 vs. no iron ) , 46 % for oral iron ( p = .6687 vs. no iron ) , and 41 % for no iron . FG was well tolerated . CONCLUSION For cancer patients with chemotherapy-related anemia receiving epoetin alfa , FG produces a significantly greater increase in Hb and Hb response compared with oral iron or no iron , supporting more aggressive treatment with IV iron supplementation for these patients BACKGROUND : It is uncertain whether anemia in elderly patients after primary hip arthroplasty has an effect on their quality of life . METHODS : We conducted a prospect i ve observational study over 3 mo to investigate the association between discharge hemoglobin levels and subjective experience of quality of life at 2 mo postoperatively in patients aged over 65 yr who were scheduled for primary hip arthroplasty .  Quality of life was measured preoperatively and at 2 mo postoperatively using the  Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and the  Functional Assessment of Cancer Therapy Anemia ( FACT-Anemia ) subscale . Pearson correlation coefficients between change in SF-36 and FACT-Anemia subscale scores ( from preoperatively to 2 mo postoperatively ) and hemoglobin on Day 8 were calculated . RESULTS : Eighty-seven patients were included in the study . Data were available at 2 mo postoperatively from 79 of these patients . The correlation between Day 8 postoperative hemoglobin and change in SF-36 was 0.49 ( P < 0.0005 ) and change in FACT-Anemia subscale score was 0.46 ( P = < 0.0005 ) . The correlation was not significantly changed after adjusting for advancing age , presence of significant cardiovascular disease , or whether the patient was transfused . CONCLUSIONS : We found a positive correlation between hemoglobin levels on discharge and change in quality of life scores from preoperatively to 2 mo postoperatively in patients over 65 yr old after primary hip arthroplasty BACKGROUND AND OBJECTIVES Patients undergoing surgery for hip fracture ( HF ) often receive perioperative allogeneic blood transfusions ( ABT ) to avoid anaemia . However , concerns about the adverse effects of ABT have prompted the review of transfusion practice and the search for a safer treatment of perioperative anaemia . MATERIAL S AND METHODS We prospect ively investigated the effect of a blood-saving protocol of perioperative iron sucrose ( 3 x 200 mg/48 h , intravenously ) plus erythropoietin ( 1 x 40,000 IU , subcutaneously ) if admission haemoglobin level < 130 g/l , on transfusion requirements and postoperative morbid-mortality in patients with HF ( group 2 ; n= 83 ) . A parallel series of 41 HF patients admitted to another surgical unit within the same hospital served as the control group ( group 1 ) .  Perioperative blood sample s were taken for haematimetric , iron metabolism and inflammatory parameter determination . RESULTS This blood-saving protocol reduced the number of transfused patients ( P < 0.001 ) , the number of transfused units ( P < 0.0001 ) , increased the reticulocyte count and improved iron metabolism . In addition , the blood-saving protocol also reduced the rate of postoperative infections ( P = 0.016 ) , but not the 30-day mortality rate or the mean length of hospital stay . CONCLUSIONS The blood-saving protocol implemented seems to reduce ABT requirements in patients with HF , and is associated with a lower postoperative morbidity . The possible mechanisms involved in these effects are discussed BACKGROUND Unilateral total knee replacement ( TKR ) can result in a substantial blood loss and 30 - 50 % of these patients receive allogeneic blood transfusion ( ABT ) , this transfusion rate may be even higher among anaemic patients . PATIENTS AND METHODS We assessed the requirements for ABT  in 156 consecutive patients undergoing surgery for primary TKR , who received iron ferrous sulphate ( 256 mg/day ; 80 mg of Fe(2 + ) ) , vitamin C ( 1000 mg/day ) and folic acid ( 5mg/day ) during the 30 - 45 days preceding surgery , and who were transfused if Hb < 80 g/L and /or clinical signs/symptoms of acute anaemia/hypoxemia ( Group 2 ) . A previous series of 156 TKR patients serves as a control group ( Group 1 ) . RESULTS Compared to those in Group 1 , patients in Group 2 presented a lower transfusion rate ( 5.8 % vs. 32 % , for Group 2 and Group 1 , respectively ; p<0.01 ) , and a lower transfusion index ( 1.78+/-0.44 vs. 2.22+/-0.65 units per transfused patient , respectively ; p<0.05 ) . After patient 's stratification according to a preoperative Hb above or below 130 g/L , the differences in transfusion rate remained significant , although 19 % of patients from Group 2 still needed ABT if their preoperative Hb < 130 g/L. CONCLUSION This protocol seems to be effective for avoiding ABT in non-anaemic TKR patients , whereas for anaemic patients another blood saving strategy , such us preoperative erythropoietin administration or postoperative blood salvage , should be added to further increase its effectiveness Objective : To determine the effect of admission hemoglobin level on patient outcome after hip fracture . Study Design : Prospect i ve , consecutive . Patients : From July 1991 to June 1997 , 395 communitydwelling patients sixty‐five years of age or older who had sustained an operatively treated femoral neck or intertrochanteric fracture were prospect ively followed up . Main Outcome Measurements : Postoperative complications , in‐hospital mortality rate , hospital length of stay , hospital discharge status , place of residence at one year , and mortality and recovery of ambulatory ability and activities of daily living status at three , six , and twelve months . Results : Women with admission hemoglobin levels below 12.0 grams per deciliter and men with admission hemoglobin levels below 13.0 grams per deciliter were classified as anemic . One hundred eighty patients ( 45.6 percent ) were considered anemic on admission . Patients who were anemic were more likely to have an American Society of Anesthesiologists rating of III or IV and have sustained an intertrochanteric fracture . Hospital length of stay and mortality rate at six and twelve months were significantly higher for patients who were anemic on admission . There were no differences in the incidence of postoperative complications , hospital discharge status , place of residence at one year , in‐hospital mortality rate , and three‐month mortality rate between patients who were and were not anemic on admission . In addition , there were no differences in the recovery of ambulatory ability and of basic and instrumental activities of daily living status at three , six , and twelve months between the two patient groups . Conclusions : Patients at risk for poor outcomes after hip fracture can be identified by assessing hemoglobin levels at hospital admission Background Total hip replacement ( THR ) is associated with a significant perioperative blood loss , and 30–50 % of these patients receive allogeneic blood transfusion ( ABT ) . We evaluated the clinical utility of washed shed blood ( WSB ) return to reduce ABT in THR patients . Study design and methods Data from 108 consecutive THR patients were prospect ively collected .  WSB salvage and reinfusion ( OrthoPAT ) was intended for 60 ( Reinfusion group ) , whereas the remaining 48 patients served as control group . Patients received ABT if haemoglobin < 8 g/dl or clinical signs and symptoms of acute anemia . Results WSB return was possible in 49 patients ( 205 ± 151 ml of erythrocyte/patient ) , without any clinical ly relevant incident . Return of WSB decreased both the ABT rate ( 48 vs. 15 % , for control and reinfusion groups , respectively ; P = 0.001 ) and the ABT index ( 371 ± 154 ml RBC vs. 53 ± 117 ml RBC , respectively ; P = 0.001 ) , without differences between cemented and uncemented THR . In addition , patients from reinfusion group showed a trend to lower postoperative infection rate ( 10 vs. 2 % , respectively ; P = 0.086 ) . Conclusions Perioperative salvage and return of WSB in THR seems to effectively reduce the requirements for ABT . However , for patients with preoperative Hb < 13 g/dl , some additional blood saving method should be associated to WSB return Patients undergoing total knee arthroplasty ( TKA ) are at high risk for postoperative anemia and allogeneic blood transfusions . Risks associated with allogeneic blood exposure ( ie , infection , fluid overload , and longer hospital stays ) have prompted alternative blood management strategies . The main goal of this study was to evaluate whether a single change in the clinical blood management of patients undergoing TKA reduced the severity of postoperative anemia or the need for allogeneic blood transfusions . A second goal of this study was to assess the financial impact of the change on the institution . This study compared perioperative cell salvage , preoperative autologous blood donation , and the practice of using allogeneic blood alone in patients undergoing TKA . Clinical and financial data of 154 unique cases of primary TKA at the Mayo Clinic Arizona were retrospectively review ed .  Transfusion rates were 25 % , 18 % , and 52 % respectively for patients in the  cell salvage , preoperative autologous blood donation , and  allogeneic blood only  groups . Respective relative risk reductions were 51.9 % ( P=.007 ) and 65.4 % ( P=.002 ) with the use of cell salvage or preoperative autologous blood donation versus allogeneic alone . Cell salvage and preoperative autologous blood donation were found to significantly reduce the requirements for allogeneic blood transfusions ; these techniques were found to be roughly equivalent in clinical benefit when compared to the use of allogeneic blood alone . The logistical advantages of cell salvage ( ie , no preoperative blood donation , no risk of wasting blood units ) were associated with greater costs to the institution OBJECTIVES To assess the risk of postoperative infection associated with blood transfusion in patients who undergo primary total hip arthroplasty . DESIGN A retrospective cohort study . SETTING Victoria General Hospital , Halifax , ( a tertiary-care centre ) . PATIENTS All patients who underwent primary total hip replacement between 1990 and 1995 ( N = 1206 ) . INTERVENTIONS Hip replacement with or without perioperative blood transfusion . OUTCOME MEASURES The rate of postoperative infection , the number of blood transfusions , patient age and sex , duration of surgery and the surgeon who performed the procedure . Victoria General Hospital medical records , the transfusion services record and the Dalhousie University Hip Study data bases were integrated and analyzed using a st and ard statistical package . RESULTS The incidence of infection postoperative was 9.9 % overall , 8.4 % in patients receiving no transfusion , and 14 % in those receiving homologous transfusion ( p = 0.035 ) . There were no infections in the 11 patients who received an autologous blood transfusion . Significant predictors of postoperative infection were sex , age and duration surgery ; these were not confounding variables multivariate analysis ) . Neither the operating surgeon nor the blood product transfused affected the infection rate . CONCLUSIONS These findings suggest an 
    Output:
    
Treatment of preoperative anemia with iron , with or without erythropoietin , and perioperative cell salvage decreased the need for blood transfusion and may contribute to improved patient outcomes .