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Anesth Analg 2005;101:1858-1861
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000184124.29397.EB

GENERAL ARTICLES

Detection, Evaluation, and Management of Anemia in the Elective Surgical Patient

Lawrence T. Goodnough, MD, Aryeh Shander, MD, Jerry L. Spivak, MD, Jonathan H. Waters, MD, Arnold J. Friedman, MD, Jeffrey L. Carson, MD, E. Michael Keating, MD, Thomas Maddox, MD, and Richard Spence, MD

Departments of Pathology and Medicine, Stanford University, Stanford, California; Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey; Mount Sinai School of Medicine, Mount Sinai Hospital; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology, Magee Women’s Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Obstetrics and Gynecology, Beth Israel Medical Center, New York, New York; Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey; Center for Hip and Knee Surgery, St. Francis Hospital, Mooresville, Indiana; Department of Family Practice, St. Luke’s Hospital of Kansas City, Kansas City, Missouri; Department of Surgery, St. Agnes HealthCare, Baltimore, Maryland

Address correspondence to Lawrence T. Goodnough, MD, Stanford University Medical Center, 300 Pasteur Drive H-1402, Stanford, CA 94305–5626. Address e-mail to ltgoodnough{at}stanford.edu. Address reprint requests to the Society for the Advancement of Blood Management, 555 East Wells Street, Suite 1100, Milwaukee, Wisconsin 53202–3823.

The prevalence of anemia in elective surgical patients may be as frequent as 75% in certain populations. A national audit demonstrated that 35% of patients scheduled for joint replacement therapy have a hemoglobin <13 g/dL on preadmission testing. Standard practice currently consists of preadmission testing 3 to 7 days before an elective operative procedure, precluding the opportunity to effectively evaluate and manage a patient with unexpected anemia. Therefore, a standardized approach for the detection, evaluation, and management of anemia in the preoperative surgical setting was identified as an unmet medical need. To address this knowledge gap, we convened a panel of physicians to develop a clinical care pathway for anemia management in this setting. Elective surgery patients should receive a hemoglobin (Hgb) determination a minimum of 30 days before the scheduled surgical procedure. Because the identification and evaluation of anemia in this setting will assist in expedited diagnosis and treatment of underlying comorbidities and will improve patient outcomes, unexplained anemia (Hgb <12g/dL for females and <13g/dL for males) should cause elective surgery to be deferred until an evaluation can be performed.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.