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Comment & Response
April 2016

Perioperative Anemia: How Low Can We Tolerate?

Author Affiliations
  • 1Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil
JAMA Surg. 2016;151(4):395-396. doi:10.1001/jamasurg.2015.4424

To the Editor We read with great interest the study by Spolverato and colleagues1 recently published in JAMA Surgery. They elegantly explore the effect of acute anemia on the perioperative period of major abdominal surgery, showing that a lower nadir hemoglobin (Hb) level and a higher percentage of individual hemoglobin loss are correlated with an increased risk of cardiovascular events among patients without preoperative anemia. Most of the evidence for the management of anemia after noncardiac surgery comes from the extrapolation of results obtained from cardiac surgery trials, with important limitations. While cardiac surgery patients are potentially more vulnerable to hemoglobin fluctuations owing to an underlying cardiomyopathy, myocardial revascularization or a valve replacement could obviate the oxygen supply-demand mismatch, attenuating the incidence of cardiac events.