Preoperative anemia optimization: role of iron supplementation

The presence of anemia in the surgical patient is highly prevalent and is associated with adverse clinical outcomes in the perioperative period. One of the three pillars of perioperative blood management is the optimization of the red blood cell mass. However, the use of allogeneic blood transfusions for anemia optimization is associated with increased risk of adverse clinical outcomes as well as increase healthcare financial costs. Therefore, the optimization of anemia has been shifted toward preference for a non-transfusional approach. Efforts aimed to mitigate the risk of allogeneic blood transfusion in anemic surgical patients by means of hematinic and nutrient supplementation are pursued to enhance perioperative outcomes. Iron deficiency is the most commonly associated etiology of anemia in surgical patients, and depending on the total body iron deposits as well as its bioavailability, it can be divided in absolute and relative iron deficiency. In both types of iron deficiency, the supplementation with parenteral iron is an effective and safe therapy to optimize the preoperative hemoglobin values, mitigating the risk of allogeneic blood transfusion by means of raising the postoperative hemoglobin nadir and avoiding reaching the transfusional threshold. There are multiple parenteral iron preparations, and its safety has been well validated.