Recommendations

Preoperative assessment guidelines
NHS Forth Valley
  1. Intravenous Iron in undifferentiated anaemic patients is not beneficial in the immediate peri-operative period.
  2. Pre-operative anaemia should be classified according to Iron studies, CRP, B12 and folate.
  3. Where HB >90 g/L, the decision to administer IV Iron due to either short notice prior to surgery or inability to defer surgery is not likely to be beneficial.
  4. Post-operative IV Iron may be useful in terms of long term Hb optimisation and decreasing readmission/infection rates.
  5. Patients with absolute Iron deficiency (Ferritin <30) are very likely to respond to iron therapy and should receive iron replacement. Patients with relative iron deficiency or co-existent inflammatory states are likely to respond less well; this group require individual risk-benefit assessment.
  6. Patients should receive a trial of PO Iron replacement in the first instance. This has cost benefit and also decreases footfall in the COVID era, although may be less effective than IV Iron. At least 4 –6 weeks is likely to be required prior to assessment of response. Once daily or alternate day dosing may be better tolerated/more efficacious than three times daily dosing in some patients.
  7. IV iron should be considered in the presence of ongoing significant anaemia where: Oral Iron has been ineffective or not tolerated There is time for the intervention to be effective (>2 weeks) Significant inflammatory component (Consultant decision).
  8. Where given, IV iron dose should be optimised according to individual patient weight and Hb level.
  9. The greater the anaemia, the greater the risk of transfusion and the greater the likely response to Iron therapy. In patients with mild anaemia e.g > 110 g/L, pragmatic response to therapy may be in the range of 0-15g/L. Unless other risk factors for transfusion exist e.g contraindication to blood products, ongoing coagulopathy/antiplatelets, low bodyweight or significant predicted blood loss, routine deferral of mildly anaemic patients is unlikely to be beneficial.
  10. Decision to defer for anaemia should not be based on anaemia alone, but should depend on:
    • Absolute Hb level
    • Urgency of surgery
    • Likelihood of peri-operative blood loss
    • Likelihood of peri-operative transfusion
    • Comorbidity and Functional status