Perioperative anaemia management

Roughly a third of surgical patients are found to have preoperative anaemia, with increased prevalence seen in children and the elderly, females, and residents of low-income regions. Perioperative anaemia is independently associated with poorer outcomes in surgery, which warrants a proactive approach to evaluation and management of anaemia. As allogeneic red blood cell (RBC) transfusion is associated with increased risk of infection and many comorbidities in patients, other modalities for treatment of anaemia and mitigation of blood loss should be employed. The appropriate approach to treatment of preoperative anaemia will depend on investigation of the patient’s underlying pathophysiology. The most common cause of preoperative anaemia is iron deficiency. Oral iron supplementation or intravenous (IV) iron, sometimes combined with erythropoiesis stimulating agents (ESAs), can effectively correct iron-deficiency anaemia prior to surgery. Techniques of intraoperative blood conservation, including intraoperative cell salvage and acute normovolemic hemodilution (ANH), along with hemostatic agents can reduce surgical blood loss and limit the need for allogeneic RBC transfusion. Effective care of the postoperative patient requires attention to limiting blood draws, optimizing nutrition, and judicious utilization of pharmacologic agents and blood component therapy. Increasing awareness of patient blood management as an overall approach and growing evidence of improved patient outcomes with blood conservation strategies will likely lead to increased adoption of best practices for management of perioperative anaemia.