Related Experiment Video
Updated: Aug 14, 2026
A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
Detection, evaluation, and management of anemia in the elective surgical patient
Lawrence T Goodnough1, Aryeh Shander, Jerry L Spivak
1Departments 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.
Insights
Anemia is common in surgical patients. Early hemoglobin testing at least 30 days before surgery is crucial for timely evaluation and improved outcomes.
Area of Science:
- Anesthesiology
- Hematology
- Surgical Patient Management
Background:
- Anemia affects up to 75% of elective surgical patients, with 35% having low hemoglobin before joint replacement.
- Current preadmission testing (3-7 days prior) is insufficient for managing unexpected anemia.
- A standardized approach for preoperative anemia detection and management is a critical unmet need.
Purpose of the Study:
- To develop a clinical care pathway for anemia management in elective surgical patients.
- To establish guidelines for timely hemoglobin assessment and evaluation.
- To improve patient outcomes through proactive anemia management.
Main Methods:
- Convened a physician panel to create a clinical care pathway.
- Recommended hemoglobin determination at least 30 days before elective surgery.
- Defined criteria for deferring surgery based on unexplained anemia.
Main Results:
- Proposed a standardized preoperative anemia detection and management pathway.
- Identified unexplained anemia (Hgb <12 g/dL females, <13 g/dL males) as a criterion for deferring surgery.
- Emphasized early evaluation to treat comorbidities and enhance patient outcomes.
Conclusions:
- Implementing a standardized anemia management pathway improves preoperative care.
- Early hemoglobin testing allows for effective evaluation and treatment of anemia.
- Deferring surgery for unexplained anemia ensures better patient safety and outcomes.
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.
Related Concept Videos
01:25Peritoneal Dialysis III: Nursing Management
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:30Venous Thrombosis IV: Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Aneurysm IV: Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management