Pre-operative anaemia

Identifying and correcting anaemia prior to elective surgery which is likely to involve significant blood loss, is an important part of Patient Blood Management.

North West Pre-op Anaemia Project

The North-West Pre-operative Anaemia project was initiated by Dr Kate Pendry (Consultant Haematologist and Clinical Director for Patient Blood Management, NHSBT). The project in the North West of England is to drive implementation of Pre-op Anaemia Management into every day practice. 

Aim
To implement a pre-op anaemia programme for patients undergoing major blood loss surgery, so that no scheduled patient with treatable anaemia comes to surgery without an attempt to correct the anaemia.

Aiming for Hb 120g/L (female) and 130g/L (male) in selected surgical procedures in 5 pilot sites:

Lancashire Teaching Hospitals NHS Foundation Trust: Upper GI

Countess of Chester Hospital NHS Foundation Trust: Elective Orthopaedics

Salford Royal Hospitals NHS Trust: Elective Orthopaedics

Blackpool Victoria Hospital: Cardiac

Pennine Acute Hospitals NHS Trust: Colorectal

The goal is to share lessons learned and good practice from the pilot sites with other Trusts, to drive best practice in pre-op anaemia management in all hospitals across the country.

The project prides itself on

• Partnership working and effective stakeholder communication
• Robust systems and processes (data collection, achievable goals, evidence of success)
• Collecting information on patient experiences
• Consultation and collaboration with Primary Care and Commissioners
• Working together to drive continuous improvements in healthcare service delivery

Business case template

• IV Iron Anaemia Clinic (Word)

Pathways

• Blackpool Teaching Hospitals NHS Foundation Trust 
  Proposed pre-op Cardiac Surgery (PDF)
  Proposed pre-op Cardiology Pathway (PDF)
  Pre-operative Hb Assessment and optimisation template pathway (PDF)
  
  
• Bolton Hospitals NHS Trust
  Anaemia Management in Primary Care (PDF)
  
  
• Central Manchester University Hospitals NHS Foundation Trust
  Pre-operative Anaemia Pathway (PDF)
  
  
• Pennine Acute Hospitals NHS Trust
  Patient Blood Management prior to Surgery (PDF)
  
  
• Stockport NHS Foundation Trust
  Pre-operative Anaemia Pathway (PDF)
  Pre-operative haemoglobin assessment and optimisation template (PDF)

Management guidelines

• Warrington and Halton Hospitals NHS Foundation Trust
  Guideline for the management of patients with anaemia (PDF)

Examples of data collection forms and GP Letters

Blackpool Victoria

• AQuA audit August 2015 (Word)
• GP Pathway (PDF)
• GP Letter A (PDF)
• GP Letter B (PDF)
• GP Letter C (PDF)
• Patient Anaemia Record (Word)

North West 

• North West Pre-operative anaemia data collection form (PDF)

Updates from each pilot site/other hospitals

• January 2016 (Word)

Workshop minutes

• March 2016 (PDF)
• November 2015 (PDF)
• September 2015 (PDF)

2015 March and April workshops 

• Outcomes (PDF)
• Measures (PDF)
• Obstacles (PDF)
• Lessons Learnt (PDF)

 Publications

• The Important Role of Intravenous Iron (PDF)
• Blood Transfusion: summary of NICE guidance BMJ
• Blood Transfusion NICE guidelines (NG24)
• How do we develop and implement a preoperative anaemia clinic designed to improve perioperative outcomes and reduce cost?
• Comparative Risk of Anaphylactic Reactions Associated With Intravenous Iron Products 
• Association between Anaemia, Bleeding and Transfusion with Long-term Mortality Following Non-Cardiac Surgery
• National guidance on Pre-op anaemia management
• References
• Reference list for ONTraC Algorithm 2013
• Implementing a blood management protocol during the entire perioperative period allows a reduction in transfusion rate in major orthopaedic surgery: a before-after study
• International consensus statement on the peri-operative management of anaemia and iron deficiency

For information please contact Joanne Bark, Patient Blood Management Practitioner on 0151 268 7041.    

See also regional transfusion committees

North West 

London