Principles

All patients listed for major surgery should have a full blood count pre-operatively. If this is abnormal, haematinics such as ferritin, transferrin saturation, B12 and folate should be checked.

Anaemia = Haemoglobin <130g/L (men) or <120g/L (women)

Causes

Investigate cause of anaemia:

• Iron deficiency (most common)
• Vitamin B12 or folate deficiency
• Renal failure
• Malignancy
• Menorrhagia
• Anaemia of chronic disease
• Drugs e.g. chemotherapy agents

Pre-operative management

Pre-operative management depends on cause and may include:

• Oral iron if >6 weeks until planned surgery
• IV iron if <6 weeks until planned surgery
• B12/folate replacement
• Erythropoiesis‐stimulating agent (ESA) therapy
• Transfusion if profound anaemia and surgery cannot be delayed