Abstract
Preoperative and postoperative anemia are associated with increased morbidity and mortality after surgery. The goals of managing anemia in the perioperative setting include optimizing hemoglobin and hematocrit, preventing unnecessary blood loss, and using red blood cell transfusions judiciously. Recent studies indicate that adhering to a restrictive transfusion threshold (transfusion for hemoglobin <7–8 g/dL) in the perioperative setting does not impact morbidity and mortality and decreases patient exposure to RBC transfusion.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Carson JL, Duff A, Poses RM, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348(9034):1055–60.
Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378(9800):1396–407.
Carson JL, Noveck H, Berlin JA, et al. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion. 2002;42(7):812–8.
Butcher A, Richards T. Cornerstones of patient blood management in surgery. Transfus Med. 2018;28(2):150–157.
.Paone G, Likosky DS, Brewer R, et al. Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. Ann Thorac Surg. 2014;97(1):87–93.
Robich MP, Koch CG, Johnston DR, et al. Trends in blood utilization in United States cardiac surgical patients. Transfusion. 2015 Apr;55(4):805–14.
Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, Arens JF, Caplan RA, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116(3):522–38.
National Institute for Health and Care Excellence (NICE). Routine preoperative tests for elective surgery. NICE guideline. 5 April 2016. Available at: nice.org.uk/guidance/ng45. Accessed 4 Apr 2018.
Stoffel NU, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol. 2017;4(11):e524–33.
Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999 Feb 11;340(6):409–17.
American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on perioperative blood management. Anesthesiology. 2015;122(2):241–75.
Hajjar LA, Vincent JL, Galas FR, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010;304(14):1559–67.
Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, et al. FOCUS investigators. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365:2453–62.
Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2012;157(1):49–58.
.Carson JL, Stanworth SJ, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion (review). Cochrane Database Syst Rev. 2016;10:CD002042.
.Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive of Liberal red-cell transfusion for cardiac surgery. N Engl J Med. 2017;377:2133–44.
ClinicalTrials.gov. National Library of Medicine (US). 2000 Feb 29. Myocardial Ischemia and Transfusion (MINT). Identifier NCT02981407. Accessed 5 Apr 2018. Available from: https://clinicaltrials.gov/ct2/show/NCT02981407.
Goodnough LT, Brecher ME, Kanter MH, et al. Transfusion medicine. First of two parts—blood transfusion. N Engl J Med. 1999;340(6):438–47.
Klein HG, Spahn DR, Carson JL. Red blood cell transfusion in clinical practice. Lancet. 2007;370(9585):415–26.
Amin M, Fergusson D, Wilson K, et al. The societal unit cost of allogenic red blood cells and red blood cell transfusion in Canada. Transfusion. 2004;44(10):1479–86.
Varney SJ, Guest JF. The annual cost of blood transfusions in the UK. Transfus Med. 2003;13(4):205–18.
.Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Berger, G., Huang, R. (2020). Anemia. In: Jackson, M., Huang, R., Kaplan, E., Mookherjee, S. (eds) The Perioperative Medicine Consult Handbook. Springer, Cham. https://doi.org/10.1007/978-3-030-19704-9_20
Download citation
DOI: https://doi.org/10.1007/978-3-030-19704-9_20
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-19703-2
Online ISBN: 978-3-030-19704-9
eBook Packages: MedicineMedicine (R0)