Preoperative Lab Testing: Clinical Care Pathway for Identification and Evaluation

No further hematology workup

6-12 weeks, CBC of Anemia in Elective Adult, Surgical Patients
No
WRHA Blood Conservation Service
Ph 787-1277 Fax 787-4529
Hgb abnormal? Ferritin
Male <130 g/L <21 mcg/L or - Give iron supplementation (oral or parenteral)
Female <120 g/L Transferrin saturation Yes - Consider gastrointestinal evaluation if iron
<15%? deficiency confirmed

Yes Yes No
Yes
Nephrology/hematology evaluation for
MCV anemia of chronic kidney disease
<80? Creatinine
>150?
Yes
No
No
Reticulocyte - Rule out blood loss
count adequate? Yes
- Rule out hemolysis
MCV
80-100?

No
Evaluation for anemia
No of chronic disease
- Test Serum B12
- Consider hematology evaluation
MCV Yes
>100?

CONSIDER EARLY CONSULTATION TO BLOOD CONSERVATION SERVICE FOR ASSISTANCE

For more info: WRHA Blood Conservation Service
Phone: (204) 787-1277 Fax: (204) 787-4529
www.bloodconservation.mb.ca

Common Oral Iron Preparations

Preparations Dose Elemental Fe Content
Fe Fumarate 300 mg/cap 99 mg
Fe Gluconate 300 mg 35 mg
Fe Sulfate 300-325 mg 60-65 mg

Intravenous Iron Preparations

Preparation Dose
Iron Dextran 25 mg test dose
500-1000 mg as per protocol
Iron Sucrose 200-500 mg IV as per protocol

Erythropoietin
Consult WRHA Blood Conservation Service 204-787-1277
Dosage: 900-1200 iu/kg in divided doses

COAGULOPATHY INTERVENTIONS

Antifibrinolytics
Indication: Massive blood loss
Dosage: Tranexamic Acid 15-30 mg/kg
0.5 g per hr for continued bleeding

rFVIIa*
Indication: Massive intractable bleeding after
attempted reversal of coagulopathy with
blood products
Dosage: 20-50 mcg/kg - may repeat twice

Prothrombin Complex*
Indication: Reversal of warfarin therapy or vitamin K
deficiency in patients having major bleeding
or requiring urgent surgical procedures
Dosage: 15-30 iu/kg, factor IX may be repeated to
a maximum of 3000 iu of factor IX

Vitamin K
Indication: Non-emergent reversal of warfarin
therapy or Vitamin K deficiency
Dosage: 10 mg I.V.

*NAC recommendations; consult transfusion medicine