title: Detection, evaluation, and management of anemia in the elective surgical patient.
abstract: 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 <12 g/dL for females and <13 g/dL for males) should cause elective surgery to be deferred until an evaluation can be performed.
authors.affiliation: 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.
authors.forename: Lawrence T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shander
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Spivak
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Waters
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Friedman
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Carson
authors.forename: E Michael
authors.initials: EM
authors.lastname: Keating
authors.forename: Thomas
authors.initials: T
authors.lastname: Maddox
authors.forename: Richard
authors.initials: R
authors.lastname: Spence
mesh_terms: D000740:Anemia / Q000175:diagnosis* / Q000188:drug therapy; D017558:Elective Surgical Procedures; D004909:Erythrocyte Indices; D004921:Erythropoietin / Q000627:therapeutic use; D006801:Humans; D011994:Recombinant Proteins
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin