Dr. Mohammed Refaei, Physicial Lead of the ONTraC Anemia Optimization Clinic, is encouraging patients and care teams to identify and treat anemia before surgery to reduce complications and support safer recoveries.
Anemia — a common but often overlooked condition — can significantly increase the risk of complications during surgery, prompting renewed calls from clinicians to screen and treat it early. As World Anemia Awareness Day approaches on February 13, physicians with the Ontario Transfusion Coordinators (ONTraC) Anemia Optimization Clinic are underscoring the importance of identifying anemia before patients enter the operating room.
“Even mild anemia increases the risk of complications during surgery,” says Dr. Mohammad Refaei, physician lead for the (ONTraC) clinic. "Optimizing anemia before surgery is one of the most effective ways we can improve patient outcomes.”
Anemia affects an estimated 30 to 40 per cent of people undergoing surgery and up to 70 per cent of patients with colorectal cancer. Yet it is frequently underdiagnosed and undertreated as many patients aren’t aware they are anemic. During pre-operative planning, conditions such as heart disease, diabetes or stopping blood thinners often takes priority, while anemia or iron deficiency is less often considered, despite their significant impact on recovery and safety.
“At ONTraC, our goal is to ensure every patient has the opportunity to enter surgery with the healthiest blood possible,” says Dr. Refaei.
“When we address anemia proactively, we reduce the need for transfusions, support faster recovery and help patients feel empowered in their own care.”
Why anemia matters before surgery
Anemia occurs when your body doesn’t have enough healthy red blood cells to carry oxygen where it’s needed. Oxygen is essential for healing, energy and organ function — especially during and after surgery.
“Anemia is especially important to address before surgeries with moderate blood loss, such as knee or hip replacement, hysterectomy and colorectal surgery,” explains Steph Scott, ONTraC Clinic Coordinator. “When we lose blood, we also lose iron, which the body needs to make healthy red blood cells. The most common cause of anemia is iron deficiency which is easily corrected with oral or IV iron treatment.”
People with anemia are more likely to experience complications such as:
- Heart attacks and strokes
- Kidney problems
- Infections and poor wound healing
- Longer hospital stays
- A higher likelihood of needing a blood transfusion
Know the signs and ask the questions
Anemia isn’t a diagnosis on its own; it’s a signal that something else may be going on. Common symptoms include:
- Feeling tired or weak
- Shortness of breath
- Dizziness or light-headedness
- Pale skin
- Restless legs
- Reduced ability to exercise or do daily activities
- Craving ice or chewing ice cubes
Common causes of anemia include low iron levels, chronic inflammation, vitamin B12 deficiency, kidney disease, uncontrolled bleeding (such as heavy menstrual bleeding or gastrointestinal bleeding), poor nutrition and certain medications or medical conditions.
Treating the underlying cause improves blood health and leads to safer surgery and smoother recovery.
Early testing makes a difference
“Early testing and treatment truly change the surgical journey for patients and for the entire care team,” says Dr. Refaei.
A simple blood test, including a complete blood count (CBC) and iron studies, can detect anemia weeks before surgery. When identified early, treatment options such as iron infusions or medications to stimulate red blood cell production can be started in time to optimize blood levels, often preventing the need for transfusions altogether.
“Ideally surgeons should draw CBC and iron studies six to eight weeks before surgery, at the signing of the surgical consent form or when a patient is in endoscopy,” Scott says.
“Oral iron can take several months to improve iron deficiency; it's often poorly tolerated due to side effects and some patients don't absorb it. If oral iron does not work or causes too many side effects, patients can be given IV iron.”
Specialized care close to home
Niagara Health’s ONTraC Anemia Optimization Clinic provides accessible assessment and treatment for patients with anemia. Talking to your care team about bloodwork early in the surgical planning process can help ensure the right steps are taken.
Be an advocate for your blood health
“Patients can advocate for their blood health by asking if their hemoglobin and iron levels have been checked by their family doctor or surgeon,” Scott says.
World Anemia Awareness Day is a reminder that patients play a powerful role in their own care. If you’re preparing for surgery, ask:
- Have my hemoglobin and iron levels been checked? If not, could I go for blood work?
- If my hemoglobin or iron is low, do I know what the cause is? Should I have other tests done to determine the cause?
- Should I be referred to the ONTraC anemia optimization clinic or receive IV iron?
