Algorithm for treating preoperative anemia

• Published in: Revista española de anestesiología y reanimación Vol. 62 Suppl 1; p. 27
• Main Authors: Bisbe Vives, E, Basora Macaya, M
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-06-2015
• Subjects: Algorithms; Anemia - diagnosis; Anemia - drug therapy; Anemia - therapy; Blood Transfusion; Elective Surgical Procedures; Folic Acid - therapeutic use; Hematinics - therapeutic use; Hemoglobins - analysis; Humans; Iron - administration & dosage; Iron - adverse effects; Iron - therapeutic use; Medical Errors - prevention & control; Preoperative Care - methods; Risk Factors; Unnecessary Procedures; Vitamin B 12 - therapeutic use; Perioperative anemia; Erythropoietin; Surgery; Anemia preoperatoria; Hemoglobin; Hierro intravenoso; Cirugía; Hemoglobina; Intravenous iron; Eritropoyetina
• ISSN: 2340-3284
• DOI: 10.1016/S0034-9356(15)30004-9

Hemoglobin optimization and treatment of preoperative anemia in surgery with a moderate to high risk of surgical bleeding reduces the rate of transfusions and improves hemoglobin levels at discharge and can also improve postoperative outcomes. To this end, we need to schedule preoperative visits sufficiently in advance to treat the anemia. The treatment algorithm we propose comes with a simple checklist to determine whether we should refer the patient to a specialist or if we can treat the patient during the same visit. With the blood count test and additional tests for iron metabolism, inflammation parameter and glomerular filtration rate, we can decide whether to start the treatment with intravenous iron alone or erythropoietin with or without iron. With significant anemia, a visit after 15 days might be necessary to observe the response and supplement the treatment if required. The hemoglobin objective will depend on the type of surgery and the patient's characteristics.