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Patient Blood Management (PBM)
Areas of Expertise

Preoperative anaemia

Facts about preoperative anaemia

Prevalence of preoperative anaemia in Switzerland1

  • Preoperative anaemia is common; 25–45% in knee and hip surgery1
  • 90% of patients with preoperative anaemia are not treated prior to elective procedures which results in 3–4 × higher transfusion rates2


Effects of preoperative anaemia on postoperative prognosis3456789

  • More frequent complications and delayed recovery10
  • Relative risk of mortality increases by 30–40% in mild anaemia, whereby the degree of anaemia directly correlates with the prognosis101112


Preoperative correction of anaemia and iron deficiency
  • Leads to faster mobilisation of patients and shorter stays in hospital91213
  • Lowers costs1415
  • Possible anaemia should be investigated 30 days prior to the procedure and corrected as needed

For example:

  • In knee, hip or spine surgery, mean preoperative iron requirements in anaemic patients are 1000 mg10
  • These preoperative iron requirements of 1000 mg can be corrected in 15 minutes with
    1 dose of Ferinject®15

With preoperative correction of anaemia:

  • postoperative anaemia can be prevented10
  • the patient recovers faster91213
  • the number and volume of blood transfusions can be reduced91213


Prior to a procedure with a high likelihood of blood loss, it can also be advantageous to top up the body’s iron stores.


  1. Spahn DR. Anemia and patient blood management in hip and knee surgery. Anesthesiology 2010; 113: 482–495.
  2. Gombotz H et al. Patient blood management (part 1) – patient-specific concept to reduce and avoid anemia, blood loss and transfusion. Anaesthesiol Intensivmed Notfallmed Schmerzther 2011; 46: 396–401.
  3. Beris P et al. Perioperative anemia management: consensus statement on the role of intravenous iron. Br J Anaesth 2008; 100: 599–604.
  4. Beattie WS et al. Risk associated with preoperative anemia in non-cardiac surgery: a single-center cohort study. Anesthesiology 2009; 110: 574–581.
  5. Dunne JR et al. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. J Surg Res 2002; 102: 237–244.
  6. Carson JL et al. Effect of anemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996; 348: 1055–1060.
  7. Gruson KI et al. The relationship between admission hemoglobin level and outcome after hip fracture. J Orthop Trauma 2002; 16: 39–44.
  8. Wu WC et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing non-cardiac surgery. JAMA 2007; 297: 2481–2488.
  9. Mehra T, et al. Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs. Transfusion 2015; Dec;55(12):2807-15
  10. Theusinger OM et al. Patient blood management in orthopaedic surgery: a four-year follow-up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich, Switzerland. Blood Trans 2014; 12: 195–203.
  11. Musallam KM et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 2011; 378: 1396–1407.
  12. Kotze A, Carter LA, Scally AJ. Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Br J Anaesth 2012; 108: 943–952.
  13. Lawrence VA et al. Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion 2003; 43: 1717–1722.
  14. Leahy MF et al. Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion. 2017; 57 (6): 1347–58.
  15. Mehra T et al. Implementation of a PBM monitoring and feedback program significantly reduces transfusions and costs. Transfusion. 2015; 55: 2807–2815.
Preoperative Anaemia | Ferinject CH
90% of patients with preoperative anaemia are not treated prior to elective procedures
which results in 3–4 X higher transfusion rates.