Background

Preoperative anaemia is common – 36% patients undergoing major surgery are anaemic. Of these anaemic patients 62% have absolute iron deficiency (Ferritin < 30 or Ferritin 30- 100/TSAT < 20 and CRP >5). Additionally, 50% of non-anaemic patients may have iron deficiency or low iron stores².

Preoperative anaemia is linked to worse outcome including perioperative complications, mortality, allogenic blood transfusion and increased length of stay. In addition, allogenic blood transfusion is linked to perioperative complications and increased length of stay.

National Guidelines promote the 3 pillars of patient blood management: 1. Optimising preoperative haemoglobin concentration; 2. Reduction of perioperative blood loss; 3. Restrictive transfusion thresholds³.

Additionally, iron deficiency anaemia may require investigation to exclude significant aetiology.

The overall incidence of iron deficiency anaemia in men/post menopausal women is 2.5%. The British Society of Gastroenterology recommend that any level of iron deficiency anaemia is investigated in men or postmenopausal women (as appropriate):

Coeliac Screen

• If +ve require OGD/Small bowel biopsy

OGD/Colonoscopy

• All men
• All postmenopausal women
• Premenopausal women – only if GI symptoms/positive family history
• Persistent anaemia despite treatment

Urine Dip

 

Investigation will only be appropriate where anaemia has not been diagnosed or investigated previously. In line with realistic medicine principles, investigation is only beneficial if it is likely to alter management and if the patient makes an informed choice to undergo investigation.

Patients with mild anaemia and a low bleeding risk may reasonably undergo surgery without further investigation or optimisation, but those with either high bleeding risk or significant anaemia should be considered for optimisation. Regardless of this decision, follow up to discuss investigation is likely to be needed in new cases of iron deficiency anaemia.