Preoperative anaemia is common, seen in a third of patients before major surgery. Both preoperative anaemia and blood transfusion are associated with increased patient risk and adverse outcome. Patient Blood Management (PBM) is the multidisciplinary, multimodal approach to optimising the care of patients who may require blood transfusion. Guidelines exist with many recommendations throughout the perioperative pathway. However, the efficacy of individual recommendations as an intervention in terms of clinical outcome can be confusing.
Intravenous iron offers and exciting alternative to blood transfusion in the surgical preparation, both for the preoperative optimisation and also the post operative recovery. The use if intravenous iron is increasing aided by modern preparations that enable a full treatment in 30 minutes. We review the actions of iron in the setting of anaemia and also no anaemic iron deficiency and also the current evidence base for PBM recommendations.
For the patient who presents with preoperative anaemia, ‘quick wins’ include identifying the cause of anaemia; preoperative discontinuation of anticoagulation or antiplatelet therapy, and intraoperative use of tranexamic acid and cell salvage.