Pre-optimization of the anaemic patient

Abstract

Anaemia affects a significant number of preoperative patients and has independently been associated with increased morbidity and mortality. Identification, assessment, and treatment of preoperative anaemia is now widely accepted as a new standard of care for patients. There remains a lack of conclusive evidence that optimizing the haemoglobin (Hb) preoperatively impacts on the increased risks, but there is increasing evidence normalizing iron stores has a positive impact.

The commonest cause of anaemia in this setting is iron deficiency. It is important to consider and exclude other causes, there are established recommendations for screening investigations. Early identification allows time for Hb optimization. Oral iron replacement is advised first line, however there are often time constraints and tolerability concerns. In some circumstances surgical delay is appropriate. It is important patients understand the rationale behind management and are involved in the decision-making process. Where possible, red cell transfusions are avoided preoperatively given associations with worse surgical outcomes, there may be circumstances however where both transfusions and erythropoiesis stimulating agents are considered.

As evidence and research in this field grows hospitals should develop preoperative anaemia care pathways to ensure appropriate screening investigations are performed and management delivered.