How to manage preoperative anemia and iron deficiency in adult heart surgery patients, see POQI/ERAS-C consensus recommendations!

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Preoperative anemia is common in patients undergoing heart surgery and is often associated
with a worse prognosis.
Iron deficiency is a major cause of anemia, and even in the absence of anemia, iron deficiency has been shown to be associated
with a poor prognosis in patients undergoing heart surgery.
Recently, the Association for the Perioperative Quality Initiative (POQI) and the Society for the Promotion of Rehabilitation After Cardiac Surgery (ERAS-C) jointly issued a consensus statement on the management of preoperative anemia and iron deficiency in adult heart surgery patients, mainly providing consensus guidance
on the management of preoperative anemia and iron deficiency in adult heart surgery patients.

Consensus recommendations

It is recommended that all patients be screened
for anemia and iron deficiency when considering surgery.
(Recommended strength: strong; Level of evidence: B)

Hemoglobin concentration testing is recommended as a screening tool
for anemia.
(Recommended strength: strong; Level of evidence: A)

Determination of ferritin and transferrin saturation is recommended as a screening tool
for iron deficiency.
(Recommended strength: strong; Level of evidence: B)

Further testing is recommended in patients diagnosed with anaemia to determine the cause and appropriate treatment (eg, diagnosis of anemia by bedside testing, creatinine, vitamin B12, folic acid, reticulocyte count, history, and physical examination, and laboratory tests including complete blood count [CBC]).

(Recommended strength: strong; Level of evidence: B)

Preoperative treatment
of anemia is recommended.
(Recommended strength: strong; Level of evidence: B)

Treatment
is recommended in patients with or without preoperative iron deficiency with or without anemia.
(Recommended strength: strong; Level of evidence: C)

In the case of limited preoperative time, intravenous iron supplementation is recommended to take precedence over oral iron supplementation for iron deficiency anemia
.
(Recommended strength: strong; Level of evidence: B)

Referral to patients for treatment with erythropoietic stimulants (ESAs) is recommended: those who refuse transfusions, those with moderate to severe anemia, and those secondary to chronic kidney disease and/or chronic inflammatory anemia
.
(Recommended strength: strong; Level of evidence: B)

A structured pathway is recommended to evaluate and treat preoperative anemia
in patients undergoing cardiac surgery.
(Recommended strength: strong; Level of evidence: B)

The use of electronic cases is recommended to provide early warning to clinicians to identify patients with anaemia and conduct further evaluation
before surgery.
(Recommended intensity: weak; Level of evidence: C)

The application of the preoperative anaemia care coordination plan is recommended as a cost-effective way to improve patient outcomes
.
(Recommended intensity: weak; Level of evidence: C)

References: Guinn NR, Schwartz J, et al.
Perioperative Quality Initiative (POQI-8) and the Enhanced Recovery After Surgery-Cardiac Society (ERAS-C) Investigators.
Perioperative Quality Initiative and Enhanced Recovery After Surgery-Cardiac Society Consensus Statement on the Management of Preoperative Anemia and Iron Deficiency in Adult Cardiac Surgery Patients.
Anesth Analg.
2022 Sep 1; 135(3):532-544.
doi: 10.
1213/ANE.
0000000000006148.