Anemia and iron before surgery

Why it matters

The WHO's policy brief on patient blood management identifies iron deficiency and anaemia as risk factors for poorer medical outcomes in surgical and non-surgical patients.^[1] The PREVENTT trial authors note that anaemia before surgery affects a high proportion of patients having major planned surgery and is associated with poor outcomes.^[2]

What iron-deficiency anemia is

The NIH's National Heart, Lung, and Blood Institute describes iron-deficiency anemia as anemia that develops when you don't have enough iron in your body. Mild cases may cause no symptoms; more severe cases can cause tiredness, shortness of breath or chest pain.^[3]

How it's checked

Doctors use blood tests, including a complete blood count (CBC), to check hemoglobin and iron levels, including ferritin.^[3] An international consensus statement sets out how to diagnose anemia and iron deficiency in surgical patients and identify who should be treated.^[4]

How it's treated

• Iron by mouth. Iron pills are the most common treatment; NHLBI notes it can take months to restore iron levels.^[3]
• IV iron. Iron given through a vein, sometimes used for severe cases or long-term conditions.^[3]
• Other treatment depends on the cause; for example, medicines that stimulate red cell production carry their own risks.^[5]

Timing

Because iron by mouth can take months to work, and IV iron in the trials above was given days to weeks ahead, it helps to ask for a blood count as soon as surgery is being planned.^{[3, 2]}