9 Pre-operative anaemia and polycythaemia

Alterations in haemoglobin are associated with increased risk of cardiovascular events not only in normal life but especially in the peri-operative setting. Anaemia as well as polycythaemia are symptoms of an underlying pathology and need further diagnostic evaluation for adequate treatment. Specific treatment of pre-operative anaemia is indicated, because simple transfusion of allogeneic blood does not necessarily reduce postoperative morbidity and mortality. Also, in patients with polycythaemia a reduction of elevated haemoglobin levels is essential to avoid complications due to hyperviscosity. In all patients the risk of allogeneic transfusion of blood products has to be calculated and alternative strategies should be taken into consideration. However, those methods have to be performed in a comprehensive multimodality programme adapted to the actual transfusion requirements, the patients' individual needs, the equipment available and the experience of the responsible physicians.