Role of iron replacement in the management of preoperative anemia

SUMMARY Preoperative anemia is an independent risk factor for allogeneic blood transfusion in surgical procedures associated with moderate‐to‐high perioperative blood loss. Allogeneic blood transfusion and preoperative anemia have been independently associated with worse postoperative outcomes in patients undergoing major surgery. In addition, hematinic deficiency may blunt the recovery from postoperative anemia. Therefore, patients scheduled for major surgery can benefit from preoperative correction of absolute or functional iron deficiency. In both cases, intravenous (IV) iron is safe and effective for treating preoperative anemia, leading to a median hemoglobin increase of 1–3 g/dL in one month, depending of the type of surgery. The availability of new IV iron formulations allowing rapid administration of high single doses may reduce the number of treatment sessions, thus contributing to a wider use of IV iron as a blood‐saving strategy in surgical patients.