Optimizing Preoperative Haematocrit in Anaemic Patients Refusing Allogenic Blood Transfusion: A Critical Review of Clinical Methods and Strategies
Edung Emem Samuel
Emergency Department, Basildon and Thurock University Hospital London NHS Trust, United Kingdom.
Osahenrhunmwen Abraham Okunorobo
Department of Clinical Pharmacy, Hello Healthcare Limited Abuja, FCT, Nigeria.
Jacques Forwah Ndeh *
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Paul-Alex Chukwuma Ifeagwazi
Department of Internal Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
Edeani Bobby David
Department of Radiation Oncology, University of Nigeria Teaching Hospital, Ituku- Ozalla, Enugu State, Nigeria.
Arinze Joseph Edochie
Queen Elizabeth Hospital Birmingham -UHB NHS Trust, United Kingdom.
Korzerzer Samuel Vershima
Department of Surgery, University of Nigeria Teaching Hospital, Ituku -Ozalla, Enugu State, Nigeria.
Otti chidiebere Joel
Department of Obstetrics and Gyneacology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.
Idiege Idiege Omang
Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Samuel Olusegun Akinwunmi
Department of Critical Care Unit, University of Teaching Hospital Initiative Limited, Lagos, Lagos State, Nigeria.
Chibuokem Chisom Chine
Department of Medicine, Central London Community Hospital, NHS Trust, United Kingdom.
Asadu Valentine Chisom
Department of Surgery, All Souls Hospital Lagos, Lagos State, Nigeria.
George Chidiebube Amaefule
Department of Surgery, Deda Hospital, Abuja, Nigeria.
Kenelumchukwu Phina Ekezie
Department of surgery, The Chiltern hospital, Great Missenden, United kingdom.
Abayomi Oluwatobi Opadijo
Department of Surgery, Goring hall Hospital, Goring by sea, Worthing, United Kingdom.
Immaculate Ihuoma Ekeagba
WORCACCCE UNION GROUP Integrated Healthcare Sciences, Technological Development and Training and Innovative Research Foundation (WUGIHSTTAIRF), P.O Box 45 Bamenda, North West Region, Cameroon.
Akaba Kingsley Onoride
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Raphael Dominic Effiong
Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Chinedum Michael Onah
Department of Mental health/Learning Disability, South Eastern Health and Social Care, Belfast, NHS Trust, United Kingdom.
Asuquo Aniekan Augustine
Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Eni Bassey Bernard
Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Abeshi Sylvester Etenikang
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Preoperative anemia is a significant challenge in patients refusing allogenic blood transfusion. Anemia is a prevalent condition among surgical patients and optimizing preoperative hematocrit or packed cell volume (PCV) is crucial to minimize perioperative complications. However, some patients refuse allogenic blood transfusions due to various reasons, including religious beliefs, fear of transfusion-related complications, or concerns about blood-borne infections. This review aims to evaluate the evidence supporting various clinical methods and strategies for optimizing preoperative haematocrit in these patients. This review also aims to identify effective clinical methods and strategies for optimizing preoperative hematocrit or PCV in anemic patients undergoing surgery who refuse allogenic blood transfusion. A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Web of Science, to identify relevant studies published between 2020 and 2025 in order to make a classification list of the various pharmaceutical and non-pharmaceutical agents and their standardized acceptable clinical methods and strategies used for optimizing preoperative hematocrit or packed cell volume (PCV) in anemic patients undergoing surgery refusing allogenic blood transfusion. The review highlights the importance of preoperative anemia management, including the use of erythropoiesis-stimulating agents, iron supplementation, tranexamic acid and optimization of underlying chronic diseases and etc. The findings of this review will provide healthcare professionals with evidence-based strategies to optimize preoperative hematocrit or PCV in anemic patients refusing allogenic blood transfusion, ultimately improving surgical outcomes and patient safety. Key findings include Iron supplementation and erythropoietin stimulating agents (ESAs) are effective in increasing haemoglobin levels and reducing transfusion requirements in preoperative anemia. Hypoxia-inducible factor (HIF) stabilizers show promise in increasing haemoglobin levels, but more research is needed to confirm their safety and efficacy. Multidisciplinary teams and institutional policies are essential for managing patients refusing blood transfusion. Conclusively, optimizing preoperative haematocrit in anaemic patients refusing allogenic blood transfusion requires a multidisciplinary approach. Evidence-supported practices such as iron supplementation and ESAs can be effective, while emerging strategies like intravenous ferric carboxymaltose and HIF stabilizers show promise. Healthcare providers must be aware of the medico-legal aspects of treating these patients and respect their autonomy.
Keywords: Anemia, preoperative optimization, hematocrit, packed cell volume, allogenic blood transfusion, surgical patients