Preoperative anaemia toolkit

The following guidance supports preoperative optimisation of anaemia. 

National guidance

The National Institute for Health and Care Excellence (NICE) provides the following guidance:

• NICE Guideline: Blood transfusion (NG24)
• NICE Quality Standard: Blood transfusion (QS138)
• NICE Clinical Knowledge Summary: Anaemia - iron deficiency

In 2024, the British Society for Haematology published an update to their guideline on identification and management of preoperative anaemia in adults.

The Centre for Perioperative Care (CPOC) has also developed a guideline on anaemia in the perioperative pathway. This is a collaborative guideline, developed using a whole pathway approach.

There are several supporting resources on the CPOC guideline page, including:

• guidance for specific staff and patient groups
• example GP letters
• patient group directives for prescribing
• patient information

The CPOC guideline also includes:

• 8 standards of care for anaemia in the perioperative pathway (PDF 21.5 KB)
• Recommendations for staff involved with children with anaemia undergoing surgery (PDF 350 KB)

NHS guidance and programmes

The National Perioperative Care Programme is one of many workstreams covered by Getting It Right First Time (GIRFT), a national NHS England programme.

It built on the CPOC's preoperative assessment and optimisation for adult surgery guidance, clinical guidance developed by a cross disciplinary, multi-specialty working group.

Following changes in the requirements for perioperative care in the NHS Standard Contract, early screening and health optimisation has been required for all inpatient pathways since April 2024.

The National Perioperative Care Programme has developed guidance to support this: Earlier screening, risk assessment and health optimisation in perioperative pathways: guide for providers and integrated care boards.

Service development

This section includes practical tools and guidance for service development and avenues for collaboration.

The Centre for Perioperative Care (CPOC) provides the following guideline: Recommendations for organisations where surgical services are provided for people who may have anaemia (PDF 38.2 KB).

The patient blood management (PBM) toolkit contains useful resources for perioperative PBM. It includes an information leaflet on 'Preoperative optimisation of iron deficiency anaemia' to guide your identification and management of anaemia in patients undergoing surgery. 

The FutureNHS Collaboration Platform hosts workspaces for collaboration, including perioperative forums within the GIRFT programme. (A FutureNHS account is required to access this content. It is free for NHS staff to join.)

Audit and improvement

Use the following resources to help promote continuous improvement.

QS138 Quality Insights is a quality improvement audit tool, enabling users to regularly self-assess compliance to the National Institute for Health and Care Excellence (NICE) Blood Transfusion Quality Standard 138. This includes preoperative iron supplementation and the use of tranexamic acid for adults undergoing moderate blood loss surgery.

The National Comparative Audit of Blood Transfusion is a national rolling programme of clinical snapshot audits that evidence appropriate use of blood components and alternatives, comparing practice to guidelines in surgical and medical settings.

The Perioperative Quality Improvement Programme (PQIP) includes preoperative anaemia. They have also produced the following guidance: 'Addressing preoperative anaemia: Ten top tips, practical advice and the evidence base'.

The PQIP Report for 5 March 2023 to March 2024 (PDF 3.8 MB) includes data on perioperative anaemia.

How patient-level costing (PLICS) can support quality improvement: this webinar by The Healthcare Financial Management Association discusses how clinicians and members of the costing team created a tool to improve preoperative anaemia management in elective surgical pathways.

The Patient Blood Management England YouTube channel contains an Anaemia playlist. The channel is regularly updated with presentations.

The Wales Blood Health National Oversight Group has developed a preoperative anaemia programme.

Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT) trial full report - The Lancet

Download supplementary information about the PREVENTT trial below:

• Summary of the PREVENTT trial (PDF 757KB)
• PREVENTT trial secondary analysis - published in Anaesthesia, on the Association of Anaesthetists website

A preoperative anaemia service to avoid unnecessary blood transfusions - Nursing Times

Alternate day oral iron dosing in iron deficiency anaemia - published in Haematologica, on the National Library of Medicine website

Current concepts in the evaluation and management of preoperative anaemia - published in Current Opinion in Anaesthesiology

International consensus statement on the perioperative management of anaemia and iron deficiency - published in Anaesthesia, on the Association of Anaesthetists website

Anaemia in the perioperative pathway: recommendations for research (PDF 25.5 KB) - Centre for Perioperative Care

Anaesthesia and Perioperative Medicine (PDF 5MB) - Getting It Right First Time (GIRFT) September 2021 report

Our patient information leaflets are available to help inform patients and support shared decision making, including leaflets on anaemia and iron in your diet.

The Centre for Perioperative Care (CPOC) has a patient information leaflet for surgical patients with anaemia: Recommendations for people with anaemia and their carers (PDF 465 KB).

They also have a webpage for patients on perioperative care: For patients - CPOC.

For additional resources and infographics for iron deficiency, please see our iron deficiency toolkit.