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

MDS: myelodysplastic syndrome; AIHA: autoimmune hemolytic anemia.

* Refer to UpToDate for details of the indications for preoperative screening for anemia.

¶ Refer to UpToDate for indications for transfusion. Transfusion is reserved for the treatment of severe or symptomatic anemia or if there is ongoing significant blood loss that would cause severe or symptomatic anemia. Tolerance of anemia depends on the patient population. Transfusion is a short-term therapy that does not address or treat the underlying cause of anemia.

Δ Refer to UpToDate for the evidence for efficacy and safety of erythropoietin in various patient populations.

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Algorithm for the management of preoperative anemia