Can Simple Preoperative Hemoglobin Testing Screen Symptomatic Anemia in Patients Undergoing Ambulatory Surgeries in Third World Countries?

Abstract

Background: Patients coming for ambulatory surgeries are mostly healthy adults and asymptomatic anemia in these patients is rare. According to international standards, perioperative period is not an appropriate setting to screen and investigate the cause of asymptomatic anemia, but in third world countries where iron deficiency is rampant, it is generally required as per local hospitals policy to test hemoglobin levels prior to any surgery in order to prevent morbidity. The purpose of our study is to look at the prevalence of anemia in patient undergoing minor elective ambulatory surgeries. Method: This was a cross sectional observational study conducted at tertiary care unit, Karachi, Pakistan. A total of 385 ASA-I (American Society of Anesthesiologist) and II patient's age ranged 18 -60 years, scheduled for day care surgical procedures were enrolled in the study. Results: Anemia was detected in 74 (19.2%) patients and its prevalence was found to be higher in females and in patients above 50 years of age. However, the presence of anemia did not have any influence on the perioperative outcomes or management. Conclusion: The routine preoperative hemoglobin testing does not have any effect on the perioperative outcomes in asymptomatic patients who are planned for elective day care surgeries.

Importance of Routine Laboratory Investigations Before Elective Surgery

“…In patients with abnormal test results peri-operative intervention was required in only 35 (0.43%) cases. Amongst abnormal test results low haemoglobin level was the most common abnormality (15.49%), as also reported from other developing countries 8 , while most studies from Western world found anaemia in less than 3% of patients 9 . Generally, low haemoglobin contributes little to patient’s surgical management or morbidity 10 and most cases of anaemia which are significant enough for patient’s management can be detected clinically 11 .…”

Routine Preoperative Hematocrit Testing in Adults Presenting for Day Case Surgery: is It Necessary in A Developing Environment

“…This is similar to the finding in this study where nine females and two males had their hematocrit less than 30% with a prevalence of 2.6%. Other researchers used the WHO definition of anemia to determine their hemoglobin cut-off level with varying prevalence of anemia ranging from 12 % in general surgical patients to 35% in patients undergoing orthopedic surgery [11][12][13]. These authors reported that more females where anemic than the males.…”

Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists

“…Literature review regarding complete blood count (CBC) revealed that some of the available studies had tested individual components of CBC, that is, haemoglobin or haematocrit, total and differential leukocyte count and platelet count, while others had tested CBC as a whole. [ 3 11 12 13 19 20 21 22 23 24 ]…”

“…Anaemia is a global health issue with a prevalence rate of approximately 14% in ASA PS 1 and 2 preoperative patients. [ 3 11 12 13 19 20 21 22 23 24 25 26 27 ] This can contribute to adverse events such as tachycardia, arrhythmias, increased risk of infection, heart failure in the perioperative period. It can also contribute to increased duration of hospital stay, rates of intensive care admission and blood transfusion, which carry their own associated risks.…”

“…Nine studies (n = 27697) tested the effects of preoperative haemoglobin/haematocrit on immediate perioperative outcomes [ Table 4 ]. [ 3 11 12 13 19 20 21 22 23 ] Most studies included combinations of minor, intermediate and major surgeries. Review of evidence indicates the need for haemoglobin testing preoperatively in patients scheduled for intermediate to major surgeries.…”