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“Anemia is not an innocent bystander.” Aryeh Shander, MD, FCCM, FCCP

Despite high prevalence rates, anemia is often undetected until its symptoms are severe, placing surgical patients at risk for poor outcomes. “Anemia is not an innocent bystander,” notes blood management expert Aryeh Shander, MD, FCCM, FCCP. In clinical studies, perioperative anemia has been identified as an independent predictor of mortality across surgical disciplines. Patient survival rates have been associated with higher preoperative hemoglobin levels, while mortality has been found to increase linearly with decreasing hemoglobin.

Anemia can have multiple etiologies. It can result from blood loss associated with heavy menstrual periods or gastrointestinal bleeding; reduced red blood cell production secondary to chronic disease or various hormonal or nutritional deficiencies; or increased red blood cell destruction, such as that seen in patients with diseased spleen or sickle cell disease. Trauma, surgery, and cancer are also common precursors of anemia. Elderly patients are a particularly vulnerable group; nearly half of elderly surgical patients have low levels of hemoglobin or are anemic, placing them at high risk for increased morbidity and mortality and the need for blood transfusion, which, in itself, is associated with poor outcomes.

Regardless of its underlying cause, the early detection and appropriate treatment of anemia are pivotal to optimal outcomes. All patients electing surgery should be evaluated for anemia preoperatively and treated appropriately before, during, and after surgery as part of a 3-tiered approach to reduce the need for transfusion. Blood conservation strategies that encompass such an approach include preoperative testing 30 days before planned surgery, if possible; acute normovolemic hemodilution intraoperatively; and cell salvage and restricted phlebotomy postoperatively.

Use of a 3-tiered approach—before, during, and after surgery—represents the optimal clinical care pathway for the management of anemia.



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