Rethinking preoperative anemia: Challenging WHO guidelines and targeting hemoglobin levels in major elective surgery

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An estimated 23%-45% of patients undergoing major surgery have anemia, with the most common causes being iron deficiency anemia and anemia of inflammation or chronic disease.

In this episode, Drs. Mojola Omole and Blair Bigham speak with Dr. Clarissa Skorupski and Dr. Yulia Lin, two authors of the practice paper in CMAJ, "Five things to know about preoperative anemia in major elective surgery." Dr. Skorupski is a third-year internal medicine resident at the University of Toronto, and Dr. Yulia Lin is the division head of transfusion medicine and tissue bank at Sunnybrook Health Sciences in Toronto. They highlight the high prevalence of preoperative anemia, its adverse outcomes, and the importance of targeting a preoperative hemoglobin level of 130 g/L for both sexes.

Next, Drs. Bigham and Omole take a critical look at the WHO guideline which sets a lower hemoglobin threshold of 120 g/L for female bodies. They speak with Dr. Michelle Sholzberg, the head of hematology-oncology and the director of the Hematology Oncology Clinical Research Group at St. Michael's Hospital in Toronto. Dr. Sholzberg argues that the WHO's sex-based hemoglobin thresholds for diagnosing anemia perpetuate structural discrimination in medicine, as they normalize anemia in females and are based on outdated data with a high risk of bias. Dr. Sholzberg describes how the policies and clinical practices following the biased thresholds may impact health-related quality of life, cognitive function, and the health of pregnant individuals and their babies.

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