Figure 1.

Consensus algorithm for pre-operative haemoglobin optimisation from the Spanish Best Practice in Peri-operative Anaemia Optimisation Panel from SEDAR (Sociedad Española de Anestesiología y reanimación)^30*.

¹ If time available for Hb optimisation prior to surgery is short, there is intolerance to oral iron, functional iron deficiency or a poor response to rHuEPO, IV iron should be administered. ² rHuEPO administration may be an off-label use for some operations, thus requiring a careful risk to benefit evaluation.

Explanatory notes: *the reduction of 1 g/dL in Hb concentration is equivalent to 150 mg iron loss. Thus, considering that 1 ng/mL ferritin is equivalent to 8 mg of stored iron, for an expected Hb decrease of 3–4 g/dL a minimum of 60 ng/mL ferritin is needed to recover from post-operative anaemia.

Hb: haemoglobin; CRP: C-reactive protein; GFR: glomerular filtration rate; IV: intravenous; rHuEPO: recombinant human erythropoietin.