Journal of Perioperative Medicine
Open Access

Optimizing Surgical Outcomes through Preoperative Anemia Management

Lei Li^{* *}Correspondence: Lei Li, Department of Perioperative Medicine, Peking University, Beijing, China, Email:

Author info »

Description

Preoperative anemia is a common condition that can significantly affect surgical outcomes. It is defined as a hemoglobin concentration lower than normal, which can reduce the oxygen-carrying capacity of the blood. Anemia, especially in patients undergoing major surgery, is associated with increased risks of complications, including prolonged hospital stays, delayed recovery and higher mortality rates. Preoperative anemia management, therefore, is important to ensure patient safety and optimizing surgical outcomes.

Preoperative anemia

Preoperative anemia can stem from a variety of causes, including nutritional deficiencies, chronic diseases and blood loss. Understanding the primary cause is essential for effective treatment. The most common forms of anemia seen in the preoperative setting include

Iron-deficiency anemia: Iron-deficiency anemia is the most common type of anemia worldwide and is often caused by inadequate dietary intake, poor absorption of iron or chronic blood loss. Iron is an essential component of hemoglobin, and when the body lacks sufficient iron, it struggles to produce adequate levels of healthy red blood cells. This type of anemia is often seen in patients with gastrointestinal disorders, heavy menstrual bleeding or those with a history of blood loss due to surgery or trauma.

Anemia of chronic disease: This type of anemia is commonly seen in patients with chronic conditions such as kidney disease, cancer, heart failure or inflammatory diseases like rheumatoid arthritis. Anemia of chronic disease occurs when chronic inflammation impairs the body’s ability to use iron and produce red blood cells effectively, leading to a mild to moderate anemia. Unlike iron-deficiency anemia, patients with this form often have adequate iron stores, but the iron is not properly utilized.

Vitamin B12 and folate deficiency anemia: Vitamin B12 and folate are key for the production of healthy red blood cells. Deficiencies in these vitamins, often caused by malabsorption disorders, inadequate dietary intake or chronic alcohol use, can lead to megaloblastic anemia. This condition results in the production of abnormally large and dysfunctional red blood cells, which are unable to carry oxygen effectively.

Hemolytic anemia: Hemolytic anemia occurs when the body destroys red blood cells faster than it can produce them. This condition can result from autoimmune diseases, genetic disorders like sickle cell anemia or thalassemia, infections or certain medications. Hemolytic anemia can complicate surgery due to its rapid onset and severity.

Iron supplementation

Iron supplementation is the keystone of treatment for irondeficiency anemia. It can be administered either orally or intravenously, depending on the severity of the deficiency, the urgency of the surgery, and the patient’s ability to tolerate oral iron.

Oral iron: Oral iron supplements, such as ferrous sulfate or ferrous gluconate, are commonly prescribed for patients with mild to moderate anemia. It is a relatively simple and costeffective option, but it can take several weeks to months to raise hemoglobin levels. Moreover, oral iron can cause gastrointestinal side effects like nausea, constipation or diarrhea, which may limit its use in some patients.

Intravenous iron: In cases where rapid correction of anemia is needed or when oral iron is poorly tolerated or ineffective, Intravenous (IV) iron is preferred. IV iron bypasses the gastrointestinal system, allowing for faster and more efficient absorption. Modern formulations of IV iron, such as iron sucrose or ferric carboxymaltose, are well tolerated and have a low risk of serious side effects.

Conclusion

Preoperative anemia is a significant risk factor for poor surgical outcomes, but with proper diagnosis and treatment, it can be managed effectively. Addressing anemia before surgery can reduce the need for blood transfusions, minimize complications and promote faster recovery. Treatment strategies, such as iron supplementation, erythropoiesis-stimulating agents and vitamin supplementation, play a key role in optimizing hemoglobin levels before surgery. By taking a proactive approach to anemia management, healthcare providers can ensure that patients are in the best possible condition to withstand the stresses of surgery and achieve optimal outcomes.