To the Editor:

We read with interest the article from Goodnough and Shander entitled “Patient Blood Management.”1The authors include an algorithm for the detection, evaluation, and management of preoperative anemia. This algorithm is based on the algorithm published in 2011 by Goodnough et al .,2and it is helpful to evaluate and treat preoperative anemia, especially in the range of 28 days before surgery. However, it strikes us that the evaluation of iron to ferritin values between 30 and 100 µg/l and/or transferrin saturation greater than 20% indicates iron therapy to rule out iron deficiency. We suggest that a transferrin saturation greater than 20% is probably incorrect, and it should be less than 20% as shown in the algorithm published in the 2011 Network for Advancement of Transfusion Alternatives guidelines, 2 which itself would be consistent with iron deficiency, and no more than 20%, which excludes iron deficiency.

Moreover, we believe that in the initial study of anemia proposed by the authors, it is useful to analyze the reticulocyte count and mean corpuscular volume to further refine the type of anemia3(e.g. , thalassemia, myelodysplasia, hemolysis) and refer the patient to a hematologist in some of these cases (e.g. , rule out thalassemia in microcytic anemia case with reticulocyte production index <2 and without iron deficiency).

, *Virgen de las Nieves University Hospital, Granada, Spain.


Goodnough LT, Shander A. Patient blood management. ANESTHESIOLOGY. 2012;116:1367–76
Goodnough LT, Maniatis A, Earnshaw P, Benoni G, Beris P, Bisbe E, Fergusson DA, Gombotz H, Habler O, Monk TG, Ozier Y, Slappendel R, Szpalski M. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth. 2011;106:13–22
Patel MS, Carson JL. Anemia in the preoperative patient. Anesthesiology Clin. 2009;27:751–60