Anemia and Transfusion Issues in Surgery

GENERAL PRINCIPLES

There is no standardized preoperative evaluation for anemia.

• For low-risk procedures, there is no evidence that routine testing of asymptomatic individuals before low-risk procedures increases safety.⁷⁸

• For higher risk procedures, particularly those with higher bleeding risk, a baseline CBC and coagulation profile are typically obtained.

DIAGNOSIS

• A history of anemia, hematologic disease, or bleeding diathesis should be noted on history or review of medical records.

• Any clinical signs of anemia (e.g., pallor) or coagulopathy (e.g., petechiae) should prompt further evaluation.

TREATMENT

Vblume resuscitation and control of active bleeding are the initial therapy of anemia, particularly in the perioperative period when acute blood loss is a common occurrence.

• A restrictive red blood cell (RBC) transfusion threshold of 8 g/dL is recommended for patients undergoing orthopedic surgery and cardiac surgery and those with preexisting cardiovascular disease.⁷⁹ In most other circumstances, a transfusion threshold of 7 g/dL suffices.

SPECIAL CONSIDERATIONS

Patients with sickle cell anemia should generally be transfused to a hemoglobin level of 10 g/dL preoperatively to decrease the incidence of complications.⁸⁰