It’s important to have a conversation with your doctor ahead of the surgery so they can assess your risk and tell you what steps to take before the surgery. Recent guidelines and medical reviews underlined the importance to assess and treat preoperative iron deficiency and/or anemia1,2,3.
Anaemia occurs when there are not enough red blood cells in your body, or the blood cells do not have enough haemoglobin to carry oxygen to your tissues (caused by iron deficiency).
Anaemia, if left untreated, may mean that the hospital has to delay your surgery4. If surgery goes ahead and you lose blood, you may need a blood transfusion5. Having a blood transfusion may make your recovery slower6. The good news is that anaemia is treatable, and the sooner you find out if you are anaemic the sooner you can start treatments to help.
To reduce your risk of higher bleeding during surgery, it is also important to discuss with your doctor:
If you are at higher risk of bleeding because of the medicines you are taking
Your medical history of current medical conditions
Whether the type of surgery may also carry an increased risk of bleeding
In addition, iron deficiency or anaemia before surgery can worsen the patient's outcome of surgery7-9, therefore it is important to have these discussions with your doctor.
Your doctor will need to know if you are likely to experience a bleed during your upcoming surgery.
This will involve asking you questions about your family history and whether you personally have experienced excessive bleeding in the past either before, or after, surgery. Your doctor will probably do a blood test to determine whether you have anaemia or iron deficiency, including the measurement of haemoglobin levels and indicators of iron metabolism10.
This will let them and you know whether you have iron deficiency, or low levels of red blood cells, and how severe it is. This will tell your doctor what the best treatment course will be.
Your doctor may prescribe you medications that contain iron in different forms, which include:
- Oral iron preparations (tablets, capsules, drops, syrup)
- Intravenous infusion or injection, which is when a dose of iron directly into your bloodstream through a vein
Increasing your iron stores by either taking medicines or having an infusion prior to surgery reduces the risk that you may need a blood transfusion during or after the surgery. This is important because blood transfusions may come with some inherent risks12-13.
Depending on the severity of your iron deficiency and anaemia, and the treatment you choose, recovery times can differ.
Existing chronic inflammatory diseases in patients undergoing surgery can interfere with the absorption of iron in the intestine and its absorption in the body. These patients often develop iron deficiency1.
This is due to the fact that inflammation activates a special protein, hepcidin, which blocks the entry of iron into the blood15. If the inflammation is chronic and prolonged, then all the cells of the body do not receive the element iron, which is important for energy metabolism16.
On the other hand, iron deficiency and anaemia can occur during treatment of the underlying disease. For example, the appointment of chemotherapy and radiation therapy can lead to iron deficiency in patients with cancer18-20.
Chronic blood loss can also cause iron deficiency in patients preparing for surgery. For example, most women with uterine fibroids have heavy menstrual bleeding, which may lead first to iron deficiency and then to iron deficiency anaemia21.
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- Hentze et al. Cell. 2010 Jul 9; 142 (1): 24-38.
- Cappellini MD et al. Am J Hematol 2017; 92: 1068–78
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- Bolotova E.V., Dudnikova A.V., Krutova V.A. Frequency and characteristics of iron deficiency states in women of reproductive age. Clinical medicine. 2020; 98 (4): 287-293
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- Richards T et al. PLoS One 2015; 10: e0130861
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- von Heymann C et al. J Thorac Cardiovasc Surg 2016; 152: 1412–1420
- Gasche C et al. Gut 2004; 53: 1190-7
- Agarwal R. Am J Nephrol 2007; 27: 565–71
- Fallah R et al. Iran J Ped Hematol Oncol 2016; 6: 32-7
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- Goodnough L. Transfusion 2012; 52: 1585–92.
- Fraenkel P.G. (2017). " Med Clin North Am 101(2): 285-296.
- Clara Camaschella, Hematology 2015.
- Madu et al., Med Princ Pract. 2017 Jan; 26(1): 1–9.
- Болотова Е.В., Дудникова А.В., Крутова В.А. Частота и особенности железодефицитных состояний у женщин репродуктивного возраста. Клиническая медицина. 2020; 98(4): 287–293.
- Fowler A.J. et al. Br J Surg. 2015; 102(11): 1314–1324.
- Kassebaum N.J. et al. Hematol Oncol Clin N Am 2016; 30: 247–308.
- Bisbe E. et al. Br J Anaesth 2014; 113: 402–9.
- Carson J.L. et al. Lancet 1996; 348: 1055–60.
- Dunne J.R. et al. J Surg Res 2002; 102: 237–44.
- Musallam K.M. et al. Lancet 2011; 378: 1396–407.
- Beattie W.S. et al. Anesthesiology 2009; 110(3): 574–581.
- Richards T. et al. PLoS One 2015; 10: e0130861.
- Bodewes T.C.F. et al. J Vasc Surg 2017; 66: 1775–1785.
- Christian von Heymann et al. J Thorac Cardiovasc Surg 2016; 152: 1412–1420.
- Munoz M. et al. Anaesthesia. 2017; 72: 233-247.
- Munoz M. et al. Blood Transfusion 2017; 15: 422-37.
- Geisser P., Burckhardt S. Pharmaceutics 2011; 3: 12–33.
- Gasche C. et al. Gut 2004; 53: 1190–7.
- Agarwal R. Am J Nephrol 2007; 27: 565–71.
- Fallah R. et al. Iran J Ped Hematol Oncol 2016; 6: 32–7.
- Vukovic-Cvetkovic V. et al. Acta Clin Croat 2010; 49: 389–94.
- Hentze et al. Cell. 2010 Jul 9;142(1): 24-38.
- Cappellini M.D. et al. Am J Hematol 2017; 92: 1068–78.