Avoiding anemia in cardiac surgery patients—strategies and protocols

Preoperative anemia is a significant risk factor for perioperative morbidity and mortality in surgical patients in general, and particularly for cardiac surgery patients. Simple correction of hemoglobin via blood transfusion is not ideal because of the various complications of blood transfusion, as well as loss of intrinsic iron stores that are not addressed with this strategy. As such, anemia prior to cardiac surgery is best handled with a systems-based preoperative blood management approach that includes preoperative screening, and addressing both anemia and iron deficiency (with or without anemia) by administering iron, and/or using erythropoietin stimulating agents. Here we review anemia subtypes, testing helpful for the perioperative clinician to delineate the etiology, and management and optimization strategies for iron deficiency with or without anemia in cardiac surgical patients.