Diagnosis And Management Of Anaemia Before Gynecologic Surgery

Anaemia is a medical condition in which the red blood cells become inefficient and are unable to carry oxygen to the tissues and organs of the body. It is important to understand the severity of anaemia and start your treatment accordingly. If you are anaemic, you are likely to feel fatigue and tiredness all throughout, even when you are not much involved in physical labour.

Symptoms of Anaemia

The following are some of the common and established symptoms of anaemia:

• Fatigue

• Weakness

• Pale or yellow skin

• Irregularity in heart rate

• Shortness of breath

• Dizziness 

• Chest pain or congestion

• Cold hands and feet

• Headaches

Diagnosis of Anaemia

It is important to look out for signs and symptoms, to check whether your body is anaemic. Signs and symptoms of anaemia can vary depending upon the cause of anaemia. It is important to understand the underlying cause of anaemia, only then your doctor can start your treatment. This is because treatment for one type of anaemia can prove to be dangerous and ineffective in curing the other type of anaemia. The following are some of the established causes of anaemia:

1. Anaemia caused due to iron deficiency:  

This is the most common type of anaemia and is caused when the body is unable to produce red blood cells, due to deficiency of iron. Our bone marrow produces haemoglobin for the red blood cells and when iron deficiency attacks the body, the red blood cells fall short of haemoglobin, causing tiredness and fatigue. In young women, iron deficiency generally occurs due to heavy menstrual bleeding. Other causes of this type of anaemia are use of pain relievers, history of ulcers or cancer.

2. Anaemia caused due to Vitamin deficiency: 

Our body needs vitamin B-12 to produce healthy red blood cells that can carry oxygen and haemoglobin throughout the body. 

3. Anaemia of inflammation:

Chronic diseases like cancer, HIV, AIDS, kidney diseases, colon diseases and other inflammatory diseases can obstruct the production of healthy red blood cells in the body.

4. Aplastic anaemia: 

This is a rare condition of the body which occurs due to use of certain inflammatory medicines, infections or any autoimmune diseases. If your body is under the attack of aplastic anaemia, it will not be able to produce enough of healthy red blood cells.

5. Anaemia associated with a bone marrow disease:

Certain diseases like leukemia and myelofibrosis, can cause anaemia as they hamper production of haemoglobin by affecting the bone marrow.

6. Sickle cell anaemia: 

This type of anaemia is generally a genetic disease. Under this condition, the haemoglobin of the body is defective and causes the red blood cells to form a crescent shape. These oddly shaped red blood cells die prematurely, causing a shortage of healthy red blood cells in the body.

Managing and Treating Anaemia- The Right Way

It is important for your doctor to identify the root cause of your anaemia and start treating it the right way. 

1. If anaemia is caused due to blood loss, the patient is treated with fluids, blood transfusion, oxygen and iron. This will help the body in building new red blood cells.

2. If anaemia is caused due to iron deficiency, iron supplements that contain ferrous form of iron will help the body cope with iron deficiency. During the treatment, it is important to monitor red blood cell counts, haemoglobin and ferritin levels.

3. Anaemia caused due to Vitamin B12 deficiency is treated with Vitamin B12 pills and injections. If the patient has folate deficiency, it is treated by folic acid supplements.

4. If the anaemia is caused due to any chronic ailment like a kidney disease, it is treated with recombinant human erythropoietin, which stimulates the production of red blood cells in the body.

5. If anaemia is caused due to red blood cells destruction, intravenous fluids and pain medication are given. A blood transfusion is also done in cases where medication does not come to the rescue.

6. If anaemia is caused due to production of sickle red blood cells, in most cases, will require a bone marrow transplant.

Managing Anaemia before Gynecologic Surgery

Managing anaemia before a patient is subjected to Gynecologic surgery forms an important part of Patient Blood Management and is often termed as checking the preoperative anaemia.

Even if the patient is suffering from a mild preoperative anaemia, it can increase the chances of mortality, when the patient is subjected to any kind of gynecologic surgery. It might also pose serious risks in blood transfusion and the chances of further blood loss increase ten-folds in such cases. It is thus, highly crucial to subject the patient to preoperative anaemia screening. This will allow time to conduct further workup and treatment and raise the haemoglobin levels.

If the patient is at multiple preoperative risks, a gynecologic surgery will further put the patient’s life at risk, for any transfusion, intraoperative organ or a difficult postoperative period. While we talk about managing anaemia before any major gynecologic surgery, a thorough risk assessment and patient blood management (PBM) should be conducted with specific procedures laid down for improving the haemoglobin levels.

In major gynecologic surgeries, a preoperative Hb <13 g/dL should be considered suboptimal women, and if the level is below the range then procedures will be started to improve the levels. If the patient needs to be put to immediate surgery, oral iron or intravenous iron formulations should be infused.