Algorithm for the management of preoperative anemia

This algorithm is intended to help clinicians determine whether surgery should be delayed for preoperative anemia. Testing for preoperative anemia is a key means of avoiding unnecessary transfusions. In many cases, a cause such as iron deficiency can be identified and treated. Clinical judgment is required to assess the urgency of surgery and the benefits of delaying surgery. For example, it may not be necessary to postpone minor procedures, such as cataract surgery. Anemia should always be evaluated for the underlying cause so that appropriate treatment can be determined.

When iron is administered, sufficient time should be allowed for correction before elective surgery (typically two to four weeks for partial correction and six to eight weeks for full correction). Intravenous (IV) iron at least 10 days before surgery is an option if semi-elective cardiac surgery is scheduled in less than four to six weeks, and for patients who cannot tolerate oral iron or do not have a response (eg, due to poor absorption). Patients with an indication erythropoietin (EPO) prior to cardiac surgery typically are treated with an EPO-stimulating agent (eg, epoetin alfa 600 units/kg weekly, or 300 units/kg daily) starting three weeks (or as short as 10 days) prior to the procedure.

Refer to UpToDate for the approach to the anemia evaluation and for treatment of specific causes of anemia.