Surgery Recovery Anemia After Surgery Causes and Treatment of Postoperative Anemia By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FN LinkedIn Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine. Learn about our editorial process Updated on October 24, 2021 Medically reviewed by Jennifer Schwartz, MD Medically reviewed by Jennifer Schwartz, MD Jennifer Schwartz, MD, is a board-certified surgeon and Assistant Professor of Surgery at the Yale School of Medicine. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Anemia Symptoms Causes and Risk Factors Diagnosis Treatment Anemia is a general term for an abnormally low number of red blood cells (RBC) circulating through the body. Anemia after surgery (called "postoperative anemia") is one of the known risks of surgery. Due to the increased risk of anemia after surgery, doctors generally run a complete blood count (CBC) before and after surgery. This blood test checks the levels of different cells in your blood, including the RBC count. A CBC can tell the surgical team if blood loss during surgery was significant enough to warrant a blood transfusion (when you receive donated blood through an IV). While a surgeon often has a good idea of how much blood you lost during surgery, a blood test can more objectively assess the degree of postoperative anemia. This article explains postoperative anemia symptoms, causes, diagnosis, and treatment. What Are the Different Types of Anemia? Verywell / Theresa Chiechi Anemia Symptoms Anemia signs and symptoms can range from mild to severe. Unfortunately, postoperative anemia is not uncommon, affecting around 90% of people following surgery. Fortunately, the problem tends to be transient (short-lived) and does not usually require a transfusion. Postoperative anemia symptoms may include: Fatigue Weakness Increased heart rate Shortness of breath Headaches Dizziness Chest pain Pale skin If anemia is present before surgery, determining the cause and correcting the problem is essential, especially if the anemia is severe. According to a 2013 review in the Journal of the Royal Society of Medicine, preoperative anemia is associated with an increased risk of postoperative infection, respiratory failure, stroke, heart attack, and kidney failure, particularly in older adults. Signs and Symptoms of Internal Bleeding Causes and Risk Factors Anemia is broadly defined as a lower-than-normal number of red blood cells or hemoglobin (the molecule that transports oxygen in red blood cells). Anemia develops when an individual makes too few red blood cells or loses an abnormally high number of red blood cells through bleeding. Bleeding is common during and after surgery and can range from mild to life-threatening. Higher Risk Some health conditions, injuries, and types of surgery increase the risk of bleeding and thus postoperative anemia, including: Open surgery (a surgery where the skin is opened with a scalpel) Trauma surgery A compound fracture of a major bone People with bleeding disorders like hemophilia (a condition that prevents blood from clotting effectively) Lowering Risk Minimally invasive surgery involving smaller incisions causes less blood loss than open surgery. Therefore, surgeons commonly advise people with bleeding disorders to undergo laparoscopy, also called "keyhole surgery," rather than an open surgery if at all possible. During laparoscopic procedures, surgeons thread cameras through small incisions that allow them to see what they are working on. Due to the smaller incision size, this often results in less blood loss. Today, surgeons can perform an increasing number of surgeries laparoscopically. Less invasive surgical incisions reduce the risk of complications and shorten recovery times. Recap Anemia occurs when there are too few red blood cells. Often this results from bleeding. Open surgery, trauma surgery, and having a bleeding disorder increase your risk of postoperative anemia. Laparoscopic surgery lowers the risk. What Is Bloodless Surgery? Diagnosis A CBC, which includes a hemoglobin test, is the primary test used to evaluate anemia before and after surgery. Each test in the CBC has a reference range of values—including an upper and lower value—between which the count is considered "normal." RBC and hemoglobin values below the reference range indicate anemia. Test Group Normal Reference Range RBC Men 4.7 to 6.1 million cells per microliter (mcL) Women 4.2 to 5.4 million mcL Children 4.0 to 5.5 million mcL Hemoglobin Men 14 to 18 grams per deciliter (gm/dL) Women 12 to 16 gm/dL Children 11 to 13 gm/dL Because postoperative anemia tends to be short-lived in healthy individuals, a transfusion is not indicated until the hemoglobin is below 7 gm/dL or 8 gm/dL in people with heart conditions. Risk of HIV From Blood Transfusions Treatment Anemia treatment varies depending on the underlying cause. For example, if an individual has iron deficiency anemia, an iron supplement is typically the best option. However, if anemia occurs due to blood loss from surgery, treatment may require a different approach. Transfusion A blood transfusion is the most immediate and effective treatment for someone with significant blood loss from surgery or trauma. The risks associated with blood transfusions are low. In rare instances, an allergic reaction may occur. Due to the routine screening of the blood supply in the United States, the risk of infections (such as viral hepatitis and HIV) is extremely low. According to the American Red Cross, the risk of HIV, hepatitis C, and hepatitis B from a blood transfusion is one per 2.3 million, 2.6 million, and 1.5 million donations, respectively. Watchful Waiting A deficiency in the essential building blocks of blood, such as iron, vitamin B12, or folate, can make it difficult to rebuild the blood supply after surgery. Therefore, your healthcare provider will routinely monitor your blood work to ensure you can recover from a trauma or surgery. The treatment is usually watchful waiting for those who experience mild anemia after surgery. Over the weeks following surgery, your body will rebuild your blood supply. Fatigue and low energy levels usually improve over time. Depending on your surgery and postoperative care, you will likely be back to your normal levels within a week or two. Recap Treatment for anemia depends on the cause. With postoperative anemia, blood transfusion and watchful waiting are the most common approaches. How Long Will Recovery Take After Surgery? Summary Postoperative anemia sometimes occurs following surgery as a result of blood loss. Open surgery, trauma surgery, and having a bleeding disorder increase your risk of postoperative anemia. Less invasive techniques, such as laparoscopic surgery, lower the risk. Treatment for postoperative anemia sometimes requires a blood transfusion, but often watchful waiting is appropriate. If you're worried that you could need a blood transfusion after surgery, talk to your surgeon about autologous blood donation. In this procedure, your blood is taken before surgery and used after surgery if needed. This process eliminates any risk of disease transmission. Donating Your Own Blood Before Surgery 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Muñoz M, Franchini M, Liumbruno GM. The post-operative management of anaemia: more efforts are needed. Blood Transfus. 2018 Jul;16(4): 324-5. doi:10.2450/2018.0036-18 D'John J, Hutchins M, Januchowski R. Medical management of anemia in the surgical patient. Osteopath Fam Phys. 2016;8(5):28-31. Partridge J, Harari D, Gossage J, Dhesi J. Anaemia in the older surgical patient: a review of prevalence, causes, implications and management. J R Soc Med. 2013 Jul;106(7):269-77. doi: 10.1177/0141076813479580 Lingohr P, Bensoukehal S, Matthaei H, et al. Value and risk of laparoscopic surgery in hemophiliacs-experiences from a tertiary referral center for hemorrhagic diatheses. Langenbecks Arch Surg. 2014;399(5):609-18. doi:10.1007/s00423-014-1185-7 National Heart, Lung, and Blood Institute. Blood transfusion. Dodd RY, Crowder LA, Haynes JM, Notari EP, Stramer SL and WR Steele. Screening of blood donors for HIV, HCV and HBV at the American Red Cross: ten-year trends in prevalence, incidence and residual risk, 2007-2016. Transfusion Med Rev. 2020 Apr;34(2):81-93. doi:10.1016/j.tmrv.2020.02.001 By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Cookies Settings Accept All Cookies