Prevalence and causes of preoperative anaemia in elective major surgery patients

Intern Med J. 2017 Dec;47(12):1400-1404. doi: 10.1111/imj.13613.


Background: Preoperative anaemia is associated with increased morbidity and mortality in surgical patients. Recent national patient blood management guideline recommended screening surgical patients for anaemia, particularly iron deficiency anaemia, without reference to the prevalence of anaemia or iron deficiency anaemia in this patient population.

Aims: To establish the prevalence and cause of preoperative anaemia in elective major surgery patients.

Methods: Patients attending the anaesthetic pre-admission clinics from 1 July 2013 to 30 June 2014 prior to their major elective surgery in our institution were screened for anaemia and iron deficiency by measuring full blood count, iron studies and C-reactive protein. Patients who were anaemic were either further assessed in the haematology clinic or had their medical records reviewed to ascertain the cause of the anaemia.

Results: Of 1494 patients, 208 (13.9%) were anaemic, with a male predominance (70.7%); 57 (27.4%) of them had iron deficiency anaemia. Other common causes of anaemia include underlying malignancy (18.3%), end-stage renal failure (11.5%) and other chronic diseases (7.2%). In 53 patients (25.5%), the cause was unknown. Anaemia was most commonly found in patients scheduled for gastrointestinal surgery.

Conclusion: Preoperative anaemia affects 13.9% of patients undergoing elective major surgery. The most common causes are iron deficiency and chronic diseases. The cause was unexplained in 25.5% of patients with anaemia. The prevalence of anaemia in different surgical specialties may have implications on the approach to screening, particularly in resource-limited areas.

Keywords: anaemia; iron deficiency anaemia; prevalence; surgical procedures.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anemia / blood
  • Anemia / diagnosis*
  • Anemia / epidemiology*
  • Anemia, Iron-Deficiency / blood
  • Anemia, Iron-Deficiency / diagnosis
  • Anemia, Iron-Deficiency / epidemiology
  • Chronic Disease
  • Cohort Studies
  • Elective Surgical Procedures / methods*
  • Elective Surgical Procedures / trends
  • Female
  • Humans
  • Male
  • Middle Aged
  • Preoperative Care / methods*
  • Preoperative Care / trends
  • Prevalence
  • Young Adult