Transfusion medicine handbook

8. Clinical Alternatives and Applications

8.7 Iron Supplementation

Preoperative identification and treatment of iron deficiency anaemia may avoid pre- and/or post-operative red cell transfusion in elective surgery. Correction of iron deficiency, even in the absence of anaemia, may improve erythropoietic recovery and reduce the risk for red cell transfusion in post-operative patients. Where red cell transfusion is required (e.g., for cardiac compromise), iron therapy should always follow, as transfusion fails to replenish deficient iron stores.

Guidance is available for patients’ undergoing procedures in which substantial blood loss is anticipated such as cardiac surgery, major orthopaedic, vascular and general surgery [13]. Specific details, including reference ranges and therapies, may need adaptation for local needs, expertise or patient groups.

A Quick Reference Guide for preoperative haemoglobin assessment is available from the National Blood Authority (Australia) at https://www.blood.gov.au/system/files/documents/pbm-module-2-qrg.pdf , the reader may find the flow chart on page 16 and the accompanying notes especially useful.