Management of preoperative anemia: The NATA consensusstatements

Preoperative anemia is highly prevalent in major surgery. The haemoglobin (Hb)
level is the main independent risk factor for allogeneic blood transfusion (ABT) in
surgeries with moderate to high risk of bleeding. Transfusion and preoperative anemia
have been associated with worse postoperative outcome and higher mortality
in patients undergoing major surgery. On the other hand, hematinic deficiency
without anemia may blunt the recovery from postoperative anemia. Thus, early
detection and appropriated treatment of anemia in the preoperative setting may
reduce the need for transfusion and its negative consequences.
Two multidisciplinary panels of physicians were convened by the ‘Network for
the Advancement of Transfusion Alternatives’ (NATA) with the aim of developing
practice guidelines for the detection and management of preoperative anemia,
reviewing the role of intravenous iron, and formulating recommendations using the
GRADE working group methodology. The panels recommend that: (1) elective
orthopedic surgical patients should have an Hb level determination 4 weeks before
surgery, if possible (Grade 1C); (2) further laboratory testing for differential diagnosis
in those with anemia (Grade 1C) and (3) nutritional deficiencies should be treated
to rising Hb before surgery to be within the normal range (Grade 1C). Finally, the
panels suggest that: (1) erythropoiesis-stimulating agents be used for anaemic
patients in whom nutritional deficiencies have been ruled out, corrected, or both
(Grade 2A) and (2) intravenous iron administration during the preoperative period
for patients undergoing orthopedic surgery who are expected to develop severe
postoperative anemia (Grade 2B).