Developing the first pan-UK multiprofessional guideline for perioperative management of anaemia: BSH22-PO119

Scarlett McNally, Hafiz R. Qureshi, Caroline R. Evans, Steven Evans, Laura Blood, Vatsala Padmanabhan, Noemi Roy, Jennifer Tam, Anjna Patel, Frances Sear, Michael Donnellon, Joanna Holland, Neeraj Bhala, Jugdeep Dhesi

Research output: Contribution to conferenceAbstractpeer-review


A third of people undergoing major surgery have anaemia. Patients with anaemia have worse outcomes from surgery.1 Anaemia is often diagnosed late in the surgical pathway and management is inconsistent. Where patients are optimised for surgery, they have fewer complications, a shorter length of stay and higher satisfaction.

Many patients do not get a gold standard approach despite a decade of literature on Patient Blood Management (PBM). Many published guidelines are specialty specific. The Centre for Perioperative Care (CPOC) aimed to create a new multiprofessional guideline for perioperative patients (from the moment an operation is contemplated until full recovery).

A wide-ranging working group was convened with representation from nursing, operating department practitioners, surgery, anaesthesia, pharmacy, obstetrics, haematology and patients. This crystallised core concepts, allowing a guideline to be produced covering all surgery, including emergency and elective surgery and for all ages from neonates to advanced years. A literature review was undertaken. Other standards and examples of good practice, including international, were collated. For patients undergoing surgery with a risk of blood loss of over 500 ml or 10% of blood volume, an active PBM plan is recommended. For others, general health optimisation advice is given.

The CPOC ethos involves pathways, empowering all staff, standardisation and harmonisation wherever possible, agreed expectations and clear red flags where a patient requires individualised care. For some patients, surgery should be delayed to optimise anaemia. For others, preoperative transfusion has a place. Patients with complex medial issues benefit from medical assessment and optimisation. A Shared Decision Making (SDM) approach formalises individual discussion considering Benefits, Risks and Alternatives to surgery and a ‘doing Nothing’ option (BRAN). At age 65, 50% of UK adults have multiple co-morbidities. Half the patients undergoing an operation requiring anaesthesia and/or admission in the UK are aged 65 or over,2 in both emergency and elective settings, and most would benefit from medical review and optimisation.

Despite the complexity of the biology of anaemia, it was possible to write clear guidance that can be applied by all staff in all cases, with an educational package. Algorithms developed help all staff plan care. Highlighting the association between functional iron deficiency and long-term disease encourages more intense medical input for such patients.

Defining clear standards, such as the early identification of anaemia, investigation of its cause and delivery of standard treatments, allows individual hospitals to improve services.

The guidance includes general concepts and specific detail. The large stakeholder group allowed messages and education to be re-packaged from one discipline to others where they were less well known (examples in Table 1).

The work highlights the poor awareness of anaemia, dietary insufficiencies and absorption problems (such as coeliac disease) among the public and health professionals. Patient-facing information can be used to support staff to empower patients. Coherent messages across pathways and professions should improve general health.
Original languageEnglish
Pages 54-170
Number of pages1
Publication statusPublished - 31 Mar 2022
Event62nd Annual Scientific Meeting of the British Society for Haematology - Manchester, United Kingdom
Duration: 3 Apr 20225 Apr 2022
Conference number: 62nd


Conference62nd Annual Scientific Meeting of the British Society for Haematology
Country/TerritoryUnited Kingdom
Internet address

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