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Updated: May 20, 2025
Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Published on: January 19, 2024
"Detect Anemia Preoperatively": A Scoping Review of Recommendations
Katja Schneider1, Diana Sauer2, Lorenz Wolf3
1From the Department of General Surgery, Bundeswehr Hospital Berlin, Berlin, Germany.
Insights
Preoperative anemia management guidelines vary globally. This review highlights the need for standardized detection methods and further research to improve evidence quality for better patient blood management.
Area of Science:
- Anesthesiology
- Hematology
- Surgical Patient Care
Background:
- Preoperative anemia negatively impacts patient outcomes, necessitating robust patient blood management (PBM).
- Timely diagnosis and differentiation of anemia are critical for effective PBM, yet implementation is inconsistent globally.
- This scoping review addresses the need for an overview of preoperative anemia management recommendations to identify knowledge gaps.
Purpose of the Study:
- To provide a comprehensive overview of current recommendations for preoperative anemia management.
- To identify inconsistencies and gaps in the detection and management of preoperative anemia.
- To highlight emerging ideas and areas for future research in preoperative anemia detection.
Main Methods:
- A scoping review was conducted following PRISMA guidelines.
- Searches of PubMed and ScienceDirect identified English and German articles from the last 5 years, supplemented by manual selection.
- Exclusion of pediatric and obstetric recommendations, with results synthesized based on key questions regarding anemia detection.
Main Results:
- Eighty articles, including 25 clinical practice guidelines, met inclusion criteria.
- Most guidelines suggest general "detect and correct" anemia; some recommend early investigations (up to 30 days pre-surgery).
- Recommended tests include blood counts, iron, vitamin B12/folate, inflammation, and organ function tests; automated algorithms and point-of-care Hb are emerging.
Conclusions:
- International recommendations for preoperative anemia detection are heterogeneous and often lack specificity.
- Automated laboratory algorithms show promise for improving the practicality of anemia detection.
- Practice-oriented guidelines and enhanced scientific evidence quality are needed for standardized and efficient implementation of preoperative anemia management.
Background:
Preoperative anemia significantly impacts patient outcomes, prompting increasing global implementation of patient blood management (PBM) measures. Timely diagnosis and differentiation of preoperative anemia are crucial components of PBM to maximize its effectiveness. Despite this, comprehensive implementation remains inconsistent. This scoping review aims to give an overview of recommendations regarding preoperative anemia management to detect gaps in knowledge and emerging ideas.
Methods:
A scoping review, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, investigated preoperative anemia detection, focusing on patient population, timing, extent, and process of investigations. PubMed and ScienceDirect were searched for English and German articles published in the last 5 years, supplemented by manual selection. Pediatric and obstetric recommendations were excluded. Results were synthesized based on key questions.
Results:
Four hundred sixty-five articles were screened, and 80 met the inclusion criteria, including 25 clinical practice guidelines. Most (n = 62) suggested "detect and correct" anemia without further specification. The rest advised conducting investigations early, ideally up to 30 days before major procedures with expected blood loss >500 mL. Recommended tests include blood counts, various iron parameters, folic acid/vitamin B12, inflammation markers, and renal, hepatic, and thyroid function tests. Ten articles described detailed algorithms. Other key recommendations included using reticulocyte hemoglobin, point-of-care Hb measurements, and automated laboratory algorithms. The underlying quality of scientific evidence is heterogeneous.
Conclusions:
International recommendations on the detection of preoperative anemia are heterogeneous and often generic. Automated algorithms could make a significant contribution to practicability. While practice-oriented guidelines, especially by surgical societies, could promote standardized and efficient implementation, further research is needed to improve the quality of underlying scientific evidence.
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