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).