Anemia is frequently seen in patients undergoing surgery, and patients with preoperative anemia are more likely to receive perioperative allogeneic blood transfusions than patients with normal hemoglobin levels. Allogeneic blood transfusions are associated with an increase in the rate of postoperative complications.

Evaluation of anemia should be performed in the preoperative period and begins with taking a detailed history and physical examination. All efforts must be used to correct anemia or reduce blood loss during surgery to avoid allogeneic blood transfusion. In this module we will discuss many scenarios commonly faced in perioperative practice.

To provide hospitalists with current information and guidelines for the treatment of perioperative anemia.

This activity is designed for hospitalists. No prerequisites required.

After completing the module, the participant should be able to:

1. Identify the risks of anemia and blood transfusion in the perioperative period. [MK]
2. Formulate an evaluation of anemia in the preoperative setting. [MK, PB]
3. Describe specific management strategies for several common causes of anemia. [MK]
4. Assess appropriate perioperative transfusion thresholds. [MK, PB]
5. Summarize available modalities to reduce the risk of allogeneic blood exposure in the perioperative period. [MK]
6. Formulate an evaluation of anemia in the postoperative setting. [MK]

Accreditation Council for Graduate Medical Education General Competency Assignments

PC Patient Care

MK Medical Knowledge

IC Interpersonal & Communication Skills

PR Professionalism

SB Systems-Based Practice

PB Practice-Based Learning & Improvement

Source: Accreditation Council for Graduate Medical Education. Common Program Requirements: General Competencies. Available at: http://www.acgme.org/outcome/comp/GeneralCompetenciesStandards21307.pdf. Published: September 28, 1999. Accessed December 4, 2009.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)^™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: April 30, 2010. Expiration date: April 30, 2012.

Estimated time to complete activity: 2 hours

Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

^*Medical Director, Internal Medicine Preoperative Center (IMPACT), Blood Management, Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland Ohio.

^†Medical Director, Hospital Medicine Program, Vice Chairman, Department of Medicine, Baptist Hospital of Miami, Miami, Florida.

Conflict of Interest: Dr Kumar and Dr Villanueva report having no relationships with commercial interests related to this activity.

Off-Label Product Discussion: The authors have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: Ajay Kumar, MRCP, MD, FACP, Medical Director, Internal Medicine Preoperative Center (IMPACT), Blood Management, Department of Hospital Medicine A13, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland OH 44195. E-mail kumara@ccf.org.

Click here to download the references for this educational activity.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study activity, and a CME post-test. All 3 sections must be completed to receive CME credit.

Supported by an educational grant from Merck & Co., Inc.