Patient Blood ManagementNARRATIVE REVIEW ARTICLEPerioperative Quality Initiative and Enhanced RecoveryAfter Surgery-Cardiac Society Consensus Statementon the Management of Preoperative Anemia and IronDeficiency in Adult Cardiac Surgery PatientsNicole R.Guinn,MD,*Jonathon Schwartz,MD,+Rakesh C.Arora,MD,PhD,Vicki Morton-Bailey,DNP MSN,AGNP-BC,S Solomon Aronson,MD,MBA,FASA,FACC,FCCP FAHA,FASE,IlCharles Scott Brudney,MC,ChB,T and Elliott Bennett-Guerrero,MD,t on behalf of the PerioperativeQuality Initiative(POQI-8)and the Enhanced Recovery After Surgery-Cardiac Society(ERAS-C)InvestigatorsPreoperative anemia is common in patients presenting for cardiac surgery,with a prevalence ofapproximately 1 in 4,and has been associated with worse outcomes including increased riskof blood transfusion,kidney injury,stroke,infection,and death.Iron deficiency,a major cause ofanemia,has also been shown to have an association with worse outcomes in patients undergo-ing cardiac surgery,even in the absence of anemia.Although recent guidelines have supporteddiagnosing and treating anemia and iron deficiency before elective surgery,details on whenand how to screen and treat remain unclear.The Eighth Perioperative Quality Initiative (POQI 8)consensus conference,in conjunction with the Enhanced Recovery after Surgery-Cardiac SurgerySociety,brought together an international,multidisciplinary team of experts to review and evalu-ate the literature on screening.diagnosing,and managing preoperative anemia and iron defi-ciency in patients undergoing cardiac surgery,and to provide evidence-based recommendationsin accordance with Grading of Recommendations.Assessment,Development and Evaluation(GRADE)criteria for evaluating biomedical literature.(Anesth Analg 2022:135:532-44)GLOSSARYoumAWP average wholesale price in US dollars:EMR electronic medical record:CBC completeblood count:CI confidence interval:CKD chronic kidney disease:ERAS-CS EnhancingRecovery After Surgery-Cardiac Society;ESA erythropoietin stimulating agents;GRADE =Grading ofRecommendations.Assessment Development and Evaluation:H&P History Physical:Hb=hemo-globin;ICU intensive care unit;IDA=iron-deficiency anemia;IV=intravenous;LMW low molecularweight;LOE=level of evidence;LOS length of stay;MRI magnetic resonance imaging:OR oddsratio;PBM patient blood management:Po per os;POC point of care;POQI PerioperativeQuality Initiative:RBC red blood cells;STS/SCA/AmSECT/SABM Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists/American Society of ExtraCorporeal Technology/Society fothe Advancement of Blood Management;TDI total dose infusion;WHO World Health OrganizationFrom the *Department of Anesthesiology,Center for Blood ConservationIffective patient blood management (PBM)Duke University Medical Center,Durham,North Carolina;fDepartment ofremains an integral component of the opti-eCoeinemal care of cardiac surgical patients.TheUniversity of Manitoba,Winnipeg,Manitoba,Canada;SClinical and Qualityrecent Socie
