Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 15. Anesthetic Considerations for the Patient with Anemia or Coagulation Disorders Edwin G. Avery, IV, MD

Key Points

"1. Anemia is common in surgical patients.

2. Hemoglobin (Hgb) concentration and hematocrit (Hct) level are appropriate tests to rapidly assess the severity of anemia.

3. Treatment of anemia should be based on the physiology and etiology of anemia. Maintenance and restoration of normovolemia and cardiac output are necessary but insufficient aims in treating anemia.

4. Tachycardia and hypotension are important clinical signs of hypovolemia and anemia, but compensatory increases in heart rate and cardiac output may be impeded by insufficient cardiac reserve or anesthetic-induced sympathectomy.

5. Consideration of the physiologic signs and laboratory evidence of inadequate tissue oxygen delivery is mandatory before making a decision to transfuse red blood cells (RBCs).

6. Because evidence-based outcomes supporting a specific transfusion trigger level of Hgb or Hct are lacking for perioperative patients, further clinical investigation is needed.

7. Alternatives to transfusion of allogeneic RBCs are available and are appropriate to integrate into a blood-conservation strategy in selected surgical patients.

8. Given the broad range of congenital and acquired disease states as well as the multiple pharmacotherapies that can result in a hypocoagulable state, serious attention..."