Detection, Evaluation, and Management of Anemia in the Elective Surgical Patient

Abstract

The prevalence of anemia in elective surgical patients may be as frequent as 75% in certain populations. A national audit demonstrated that 35% of patients scheduled for joint replacement therapy have a hemoglobin <13 g/dL on preadmission testing. Standard practice currently consists of preadmission testing 3 to 7 days before an elective operative procedure, precluding the opportunity to effectively evaluate and manage a patient with unexpected anemia. Therefore, a standardized approach for the detection, evaluation, and management of anemia in the preoperative surgical setting was identified as an unmet medical need. To address this knowledge gap, we convened a panel of physicians to develop a clinical care pathway for anemia management in this setting. Elective surgery patients should receive a hemoglobin (Hgb) determination a minimum of 30 days before the scheduled surgical procedure. Because the identification and evaluation of anemia in this setting will assist in expedited diagnosis and treatment of underlying comorbidities and will improve patient outcomes, unexplained anemia (Hgb <12 g/dL for females and <13 g/dL for males) should cause elective surgery to be deferred until an evaluation can be performed.

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

“…[22][23][24][25][26][27][28][29][30][31][32][33][34] Our data confirm that patients in the Pre-Protocol group with Fig. 3 The impact of protocol implementation in anemic (Hb \ 120 gÁL -1 ) and non-anemic patients (Hb [ 120 gÁL -1 ) is demonstrated.…”

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

“…Reports have demonstrated that about 35% of patients undergoing joint arthroscopy or non cardiac surgery have anaemia while about 76% of patients with Dukes stage D colon cancer have low haemoglobin levels before surgery [17][18][19]. Furthermore, previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality [20].…”

“…This indicates that there is an increasing interest among health providers for optimizing the management of pre-operative anaemia with the aim of improving outcome and reducing blood transfusion, especially with the current shortage of blood supply. Moreover, many cases of preoperative anaemia are associated with depleted iron stores [19][20][21][22][23].…”

Transurethral Resection of the Prostate and Pre-Operative Anemia, in Men Older Than 60 Years

“…Within a preoperative preparation, anemail etiology should be determined and its treatment should start before the scheduled surgical procedure (3). There are diverse therapeutic options depending on the etiology, such as iron therapy, erythropoietin therapy or autologous transfusion administration such is preoperative autologous blood donation (3,25,26). This would significantly reduce perioperative complications and the length of hospitalization.…”