Treating Preoperative Anemia to Improve Patient Outcomes After Orthopaedic Surgery

Satish P. Shanbhag, Mitchell A. Solano, Mina A. Botros, Harpal S. Khanuja

Research output: Contribution to journalReview articlepeer-review


For patients undergoing orthopaedic surgery, preoperative risk modification and control of comorbidities can maximize safety and improve outcomes. Anemia is common among orthopaedic patients, and its prevalence increases with patient age. Although surgeons are well versed in intraoperative blood conservation, preoperative anemia treatment is often deferred to primary care physicians, who may not understand the importance of a thorough assessment and treatment. Orthopaedic surgeons should understand the causes and treatments of anemia to advocate that patients receive appropriate preoperative care. Mean corpuscular volume and reticulocyte count can help determine the cause of anemia and assess the bone marrow’s ability to produce red blood cells. These values can be used to aid in diagnosis and treatment plans. Iron deficiency anemia, the most common type, is a microcytic anemia easily treated with iron supplementation. In cases of trauma, anemia can be related to acute blood loss and underlying conditions. Fracture patterns and preexisting comorbidities should be assessed. The role of intravenous iron supplementation in this setting has not been clearly shown. Patients needing urgent procedures that might involve substantial blood loss should receive transfusions if they have hemoglobin levels,8 g/dL or symptomatic anemia.

Original languageEnglish (US)
Pages (from-to)E1077-E1085
JournalJournal of the American Academy of Orthopaedic Surgeons
Issue number24
StatePublished - Dec 15 2019

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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