An Anaesthesia review surveys optimizing preoperative anemia.
Anemia in surgical patients is linked to increased morbidity, kidney failure, infection and mortality. Blood transfusion is also linked to worse outcomes and therefore strategies to optimize anemia preoperatively are important, although the evidence that this will improve outcome is limited but ongoing. 130g/dL is the proposed trigger in both sexes, as the WHO figure of 120g/dL in women would disadvantage them.
Targets for anemia correction include cardiac, obstetric, orthopedic and oncological patients.
Screening is advised at least 30 days before surgery, and at the latest 14 days preoperatively. This may involve Ferritin, Transferrin, CRP, B12, Folate and Crestinine measurement. Logistics and team liaison including primary care is needed.
Oral iron is appropriate if 6 weeks before surgery; intravenous iron is recommended if within 4 weeks of surgery. Erythropoietin is not routinely advised because of the potential for increased thrombotic events and mortality, but may be considered where blood is refused or difficult to obtain.