Which should be the target for preoperative hemoglobin optimization?

Abstract

Preoperative anemia and non-anemic iron deficiency are risk factors for postoperative morbidity and mortality. In the context of a comprehensive patient blood management program, both preoperative anemia and hematinic deficiencies, especially iron deficiency, should be screened and treated, as appropriate. According to most recent clinical guidelines and consensus documents, patients scheduled for a major surgical procedure and presenting with preoperative hemoglobin <13 g/dL, irrespective of gender, should be considered anemic.  This hemoglobin cutoff has been recently challenged, but we consider data inconclusive. Waiting for new evidence, the treatment target should be the correction of hematinic deficiencies and attaining a hemoglobin of at least 13 g/dL on admission, with its upper level tailored to patient and procedure characteristics.