Anaes · Perioperative medicine
Preoperative anaemia and iron therapy
Also known as Patient blood management anaemia · IV iron preoperative · PREVENTT trial · Iron deficiency anaemia surgery
Exam-pass preoperative anaemia: thresholds, iron studies, oral vs IV iron, PREVENTT caveats, ESA use, PBM pillars, and transfusion decisions for ANZCA Final and equivalents.
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Red flags
- Do not expect day-before IV iron to erase major surgical transfusion need.
- Ferritin misleads in inflammation — use TSAT and CRP context.
- Ignoring treatable iron deficiency before elective major surgery fails PBM.
- IV iron reactions are rare but require anaphylaxis readiness.
- Transfusion is not a substitute for investigating elective anaemia.
Meet the patient
A 68-year-old man scheduled for elective open colectomy in three weeks has a haemoglobin of 102 g/L at preassessment. His ferritin is 22 µg/L, CRP is normal, and TSAT is 15 percent. The surgeon says the list is fixed.[1]
Two questions decide whether this patient is optimised in time: what type of anaemia is this? (absolute iron deficiency, given the ferritin under 30 with normal CRP) and can you treat it before surgery? (three weeks is enough for IV iron to work, but oral is a gamble at this lead time).[1]
References3ShowHide
- [1]Richards T, Baikady RR, Clevenger B, et al. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial Lancet, 2020.PMID 32896294
- [2]Shander A, Corwin HL, Meier J, et al. Recommendations From the International Consensus Conference on Anemia Management in Surgical Patients (ICCAMS) Ann Surg, 2023.PMID 36134567
- [3]Gómez-Ramírez S, Bisbe E, Shander A, et al. Management of Perioperative Iron Deficiency Anemia Acta Haematol, 2019.PMID 30970362