Preoperative Anemia Management: What’s New in 2020?

Purpose of Review The purpose of this article is to review the relevant evidence regarding the clinical impact of preoperative anemia, current methods of identifying anemia in the surgical population, and the current and upcoming evidence for the treatment modalities targeting preoperative anemia. Recent Findings Preoperative anemia continues to be identified as a contributor to poor outcomes in the surgical population. Identifying anemia typically starts with hemoglobin and mean corpuscular volume. Recent laboratories have also started using iron studies with serum ferritin and transferrin saturation. Oral and IV iron have demonstrated efficacy in treating preoperative anemia in terms of increasing hemoglobin preoperatively and reducing allogeneic blood transfusions. However, few studies have demonstrated an impact on patient outcomes, morbidity, and mortality. Additionally, several meta-analyses have demonstrated the benefit of adding erythropoietin-stimulating agents to improve anemia. Summary Preoperative anemia is very common and is thought to be a contributor to poor outcomes. IV iron is currently recommended by several guidelines as the primary treatment modality for preoperative anemia. Two ongoing studies hope to provide clarity on the effect of IV iron on patient outcomes including morbidity and mortality in cardiac and non-cardiac surgical populations.