The impact of an algorithm-guided management of preoperative anemia in perioperative hemoglobin level and transfusion of major orthopedic surgery patients.

This is an interesting retrospective before-after study to evaluate a laboratory-guided therapeutic algorithm for preoperative anemia, based on Thomas-plot that required reticulocyte hemoglobin content and soluble transferrin receptor/log ferritin ratio. Accordingly, to distinguish iron deficiency anemia from anemia of chronic disease the authors gave high doses of intravenous iron (1000 mg) with low-dose EPO (1000 IU) or high-dose EPO (40,000 IU) plus a low dose of intravenous iron (200 mg), respectively. They found a significant improvement in hemoglobin progression and a significant reduction of transfusion.

The authors conclude that this diagnostic tool allows a more precise classification of preoperative anemia for guiding clinical decisions than NATA guidelines. However, the cost and the availability of most of these laboratory tests are a major limitation. Furthermore, there are no prospective studies evaluating the utility of this tool or comparing its efficacy with NATA guidelines.

– Elvira Bisbe