Anemia, a condition with a lower-than-normal amount of healthy red blood cells or hemoglobin, is a frequent concern for patients preparing for surgery. Hemoglobin, a protein in red blood cells, carries oxygen throughout the body. When anemia is present, the body’s capacity to transport oxygen is reduced. Medical professionals have established protocols to manage this condition safely before, during, and after surgical procedures.
Why Anemia Poses Surgical Risks
Anemia presents several concerns for individuals undergoing surgery due to the vital role red blood cells play in oxygen transport. Red blood cells deliver oxygen to all tissues and organs, a process critical during surgery. Reduced oxygen delivery can strain vital organs, potentially leading to complications.
Patients with anemia have a decreased tolerance for blood loss, which is common during many surgical interventions. This can lead to a significant drop in hemoglobin levels. Anemia can also impair wound healing and increase the risk of postoperative infections. The cardiovascular system may also experience increased strain as the heart works harder to compensate for reduced oxygen-carrying capacity.
Pre-Surgical Anemia Assessment
Healthcare providers carefully evaluate a patient’s anemic status before surgery. A complete blood count (CBC) is a primary test, measuring red blood cells, hemoglobin, and hematocrit levels. Hemoglobin values below 130 g/L for men and 120 g/L for women generally indicate anemia.
Identifying the specific type and underlying cause of anemia is crucial for guiding treatment. Common causes include iron deficiency, vitamin B12 deficiency, or anemia of chronic disease. Further tests, such as iron studies (ferritin, transferrin saturation) and vitamin B12/folate levels, help pinpoint the exact deficiency. The severity of the anemia significantly influences surgical planning, including whether to proceed or postpone the procedure.
Managing Anemia Before Surgery
Optimizing a patient’s hemoglobin levels before surgery is an important step in mitigating risks. Oral iron supplementation is often the first approach for iron deficiency anemia, provided there is sufficient time, typically 6 to 8 weeks before surgery. These supplements can increase hemoglobin and ferritin levels.
For patients unable to tolerate oral iron, those with severe anemia, or when surgery is less than 8 weeks away, intravenous (IV) iron infusions are often considered. IV iron can rapidly increase blood counts, often within 2 to 4 weeks, and may be more effective in the presence of inflammation. Studies suggest that preoperative IV iron infusions may lead to better outcomes, including lower risks of postoperative complications and reduced need for blood transfusions.
Erythropoietin-stimulating agents (ESAs) may be used for patients with anemia of chronic disease or kidney insufficiency to encourage the body to produce more red blood cells. Pre-operative blood transfusions are generally reserved for severe anemia or urgent surgical situations. The decision to postpone elective surgery to treat anemia is made on an individual basis, balancing treatment time against procedure urgency.
Anemia Care During and After Surgery
Care for anemic patients extends throughout the surgical period and recovery. During surgery, strategies focus on minimizing blood loss through careful surgical techniques. Blood salvage, where a patient’s own blood is collected, processed, and reinfused, can reduce the need for donor blood.
After surgery, continued monitoring of hemoglobin levels is important, as postoperative anemia is common. Ongoing treatment for anemia, such as oral or intravenous iron therapy, is often necessary to support recovery and replenish stores. Managing any postoperative bleeding is crucial to prevent further drops in hemoglobin and avoid complications.