We are advising the orthopaedic SpR, Ms Fi Moor, about a 71 year old lady listed for urgent THR who has a normocytic anaemia (Hb 84) and requires optimisation pre-op. You have requested the following info:
PMH: Hypertension, type 2 diabetes, rheumatoid arthritis, CKD stage 2
No recent surgery, trauma. Diet normal.
DH: Ramipril, metformin, atorvastatin, methotrexate, aspirin, folic acid
Main symptoms are pain and lack of mobility in hip. No SOB, not dizzy, no chest pain.
Surgeons think procedure is low bleeding risk, but ‘you never know.’ They would ideally like Hb > 100 g/l.
Further tests as requested:
Ferritin 180 ug/l
Serum iron 5 umol/L
Transferrin 1,480 mg/L
TIBC 43 umol/L
B12 239 ng/L
Folate >20.0 ug/l
U&Es Na 141, K 4.5, Ur 12.2, Cr 180, eGFR 65
Bone profile Normal
Film has been reviewed by BMS: ‘Minor anisopoikilocytosis with occasional left-shifted neutrophil. No primitive cells, no dysplasia.’
Surgery is planned in the next few months.
Do you require any further investigations?
What treatment would you suggest to optimise Hb before surgery?
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