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Management of anemia needed before and after elective surgery

November 24, 2015

Lately, increased attention has been paid to anemia among orthopaedic patients who undergo major planned elective surgery, such as lower limb joint reconstruction or spine surgery, since some recent publications have documented that these patients more frequently require postoperative blood transfusions. Because we see more elderly patients today and they lead a more active lifestyles than in the past, more of them are referred for reconstructive surgery. Therefore, we will need clear guidelines for anemia to assist both orthopaedic surgeons and anesthetists.

There are several issues. One concerns the initial level of hemoglobin (Hb) at which a patient scheduled for surgery is considered anemic. Some investigators propose 130 g/L Hb as the level for anemia. If that is an accepted level, by some accounts 35% of the U.S. population would have anemia. Other researchers discuss the fact that Hb less than 100 g/L always needs attention, while other reports say it is acceptable for Hb to decrease to 80 g/L before anything needs to be done. However, still other studies report different Hb levels are acceptable for men and women, and even the levels for women vary depending on whether the woman is premenopausal or postmenopausal.

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