Society for the Advancement of Patient Blood Management

View all recommendations from this society

July 23, 2018

Don’t proceed with elective surgery in patients with anemia until properly diagnosed and treated.

Anemia is common, presenting in approximately one-third of patients undergoing elective surgery. There is often the misconception that anemia is harmless, when, in fact, it is independently associated with significant morbidity and mortality. Appropriate diagnosis followed by treatment of anemia improves blood health, optimizes patient readiness for surgery, aids in management of comorbid conditions, decreases length of stay and readmission rates, and minimizes the need for transfusion. Treatment modalities may include nutritional supplementations, such as iron, B12 and folate, changes in medication, management of chronic inflammatory conditions, or other interventions based on the etiology. It is optimal to allow 2-4 weeks, when possible, for diagnosis and management prior to surgery to allow for optimal hemoglobin recovery.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Executive Committee and Board of Directors (BOD) of the Society for the Advancement of Patient Blood Management (SABM) had a strong desire to participate in the Choosing Wisely campaign. Participation allows SABM to align with the national Choosing Wisely® team and other specialty societies to further the mission of collaborative physician-patient health care delivery and responsible use of resources.

A Task Force was appointed from within the BOD to draft the initial set of recommendations. Evidence-based recommendations were based on our society’s foundational pillars and structured around published SABM Standards. A critical feature was the review of relevant literature for supporting evidence applicable to each statement. Ultimately, the draft recommendations were submitted to the membership for input via an email survey. This resulted in the final five statements for which evidentiary materials and pertinent references were written. The BOD approved the materials prior to submission. Recent review with updates was undertaken by the SABM Educational Oversight Committee.

Working with this initiative, our selected recommendations and integrated materials were further honed based on subsequent campaign review. This list and supporting material resulted in a publication in a peer-reviewed journal in 2019. SABM will also develop monitors to assess the impact of the initiative for our members and hospital affiliates. We foresee this as a vehicle for outreach to other professional societies, health care providers and patients.


Mursallana KM, Tamim HM, Richards T et al. Preoperative anaemia and post operative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 2011; 378 (9800): 1396-4007.

Koch C, Li L, Sun Z et al. Hospital-acquired anemia: prevalence, outcomes, and healthcare implications. J Hosp Med 2013; 8(9): 506-512.

Beattie WS, Karkouti K, Wijeysundera DN, Tait G et al. Risk associated with preoperative anemia in non-cardiac surgery; a single-center cohort study. Anesthesiology 2009; 110 (3): 574-581.

Munoz M, Acheson AG, Aurbach M et al. International consensus on peri-operative anemia and iron deficiency. Anaesthesia 2017; 72: 233-247.

Patient Blood Management Gombotz, Zacharowski & Spahn (eds.), Thieme Publishers, 2016.