A focused evaluation of the incidence and current management of pre-operative anaemia in a teaching hospital

Authors
Stott M, Chandini C, Gwinnutt M
Aintree University Hospital NHS Foundation Trust, Liverpool, UK

Background
The aim was to quantify the number of patients presenting for surgery across all specialties in our hospital with pre-existing anaemia. This will then be used as a driver to introduce a pre-operative anaemia management service.

We defined anaemia according to the World Health Organisation (WHO) criteria of a Haemoglobin (Hb) concentration of <120d/L for females and < 130g/L for males1.

Methods
All patients seen in the pre-operative assessment clinic during a two-week period who had a full blood count performed were identified. Their demographics, date of pre-operative assessment and planned date of surgery, surgical specialty and procedure, Hb concentration, and mean corpuscular volume (mcv) was all recorded. Quantitative analysis was performed to determine the proportion of patients who were anaemic, and of these which had a microcytic anaemia (mcv <80x10-15L).

Results
322 patients, of whom 164 (50.9%) were male, were identified. Overall 54 (16.8%) (18.9% of males and 14.6% of females) patients were anaemic, however of these only 7 (13.0%) had a microcytic anaemia. The median duration from pre-operative assessment to planned date of surgery was 7 days. 

Conclusion
Pre-operative anaemia is a significant problem in the surgical patient population of our hospital. The cause of the anaemia may be multi-factorial, but it looks as though iron deficiency certainly features amongst our patients. This highlights a need to develop a formal pre-operative anaemia management service including assessment of haematinics and a iron replenishment regime. A barrier to achieving this is the short duration from pre-operative assessment to surgery. This will need to be increased from a median of 7 days to around 28-42 days to allow adequate time fro investigation and treatment.

References
1. World Health Organization . Nutritional Anaemias: report of a WHO Scientific Group (meeting held in Geneva from 13 to 17 March 1967) Geneva: World Health Organization; 1968.

Declaration of Interests
None of the authors have any interests to declare