Newly Published
Perioperative Medicine  |   March 2020
An Effective and Efficient Testing Protocol for Diagnosing Iron-deficiency Anemia Preoperatively
Author Notes
  • From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (O.O., M.J.A., B.J.S.); and Midwestern University, Downers Grove, Illinois (H.D.).
  • Part of the work presented in this article has been presented at the Association of University Anesthesiologists Annual Meeting in Montreal, Canada, May 16, 2019, and the International Anesthesia Research Society Annual Meeting in Montreal, Canada, May 19, 2019.
    Part of the work presented in this article has been presented at the Association of University Anesthesiologists Annual Meeting in Montreal, Canada, May 16, 2019, and the International Anesthesia Research Society Annual Meeting in Montreal, Canada, May 19, 2019.×
  • Submitted for publication July 23, 2019. Accepted for publication February 20, 2020.
    Submitted for publication July 23, 2019. Accepted for publication February 20, 2020.×
  • Correspondence: Address correspondence to Dr. Sweitzer: 251 E. Huron Street, Feinberg 5-704, Chicago, Illinois 60611. bobbiejean.sweitzer@nm.org. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Endocrine and Metabolic Systems / Hematologic System
Perioperative Medicine   |   March 2020
An Effective and Efficient Testing Protocol for Diagnosing Iron-deficiency Anemia Preoperatively
Anesthesiology Newly Published on March 17, 2020. doi:https://doi.org/10.1097/ALN.0000000000003263
Anesthesiology Newly Published on March 17, 2020. doi:https://doi.org/10.1097/ALN.0000000000003263
Abstract

Background: Iron-deficiency anemia is a common perioperative condition and increases perioperative morbidity and mortality. Timely diagnosis and treatment are important. This retrospective cohort study tested the hypothesis that a newly developed preprocedure evaluation protocol diagnoses more patients with iron-deficiency anemia than the traditional practice of obtaining a complete blood count followed by iron studies.

Methods: The preprocedure anemia evaluation is an order for a complete blood count and reflex anemia testing, which can be completed with a single patient visit. A hemoglobin concentration of 12 g/dl or less with serum ferritin concentration less than 30 ng/ml or transferrin saturation less than 20% defined iron-deficiency anemia. Northwestern Medicine’s database was queried for preoperative clinic patients, age 16 to 89 yr, before (2015 to 2016) and after (2017 to 2018) protocol implementation. The proportion of patients diagnosed with iron-deficiency anemia before and after the preprocedure anemia evaluation implementation was compared.

Results: Before implementing the protocol, 8,816 patients were screened with a traditional complete blood count. Subsequent iron studies at the providers’ discretion diagnosed 107 (1.2%) patients with iron-deficiency anemia. Some patients were still screened with a complete blood count after implementing the protocol; 154 of 4,629 (3.3%) patients screened with a complete blood count and 738 of 2,828 (26.1%) patients screened with the preprocedure anemia evaluation were diagnosed with iron-deficiency anemia. The preprocedure anemia evaluation identified a far larger proportion of patients with iron-deficiency anemia than did the traditional complete blood count when compared both before (relative risk [95% CI], 21.5 (17.6 to 26.2); P < 0.0001) and after (7.8 [6.6 to 9.3]; P < 0.0001) its implementation.

Conclusions: The preprocedure anemia evaluation improved identification of iron-deficiency anemia preoperatively. It is more effective and efficient, allowing anemia evaluation with a single patient visit.

Editor’s Perspective:

What We Already Know about This Topic:

  • Iron-deficiency anemia is common and increases perioperative morbidity and mortality

  • Timely diagnosis facilitates treatment and may reduce complications

What This Article Tells Us That Is New:

  • The investigators implemented a novel screening system in which anemia automatically triggered evaluation for iron deficiency using previously collected blood

  • The automated system identified iron-deficiency anemia far better than clinicians using normal procedures