Open Journal of Anesthesiology, 2012, 2, 150-153 http://dx.doi.org/10.4236/ojanes.2012.24034 Published Online September 2012 (http://www.SciRP.org/journal/ojanes) Can Simple Preoperative Hemoglobin Testing Screen Symptomatic Anemia in Patients Undergoing Ambulatory Surgeries in Third World Countries? Sobia Khan 1 , Mueen Ullah Khan 2 , Khalid Samad 1 1 Department of Anesthesia, Aga Khan University Hospital, Karachi, Pakistan; 2 Department of Anesthesia, King Khalid University Hospital, Riyadh, KSA. Email: sobia.khan@aku.edu, khalid.samad@aku.edu Received June 19 th , 2012; revised July 21 st , 2012; accepted August 10 th , 2012 ABSTRACT Background: Patients coming for ambulatory surgeries are mostly healthy adults and asymptomatic anemia in these patients is rare. According to international standards, perioperative period is not an appropriate setting to screen and investigate the cause of asymptomatic anemia, but in third world countries where iron deficiency is rampant, it is gener- ally required as per local hospitals policy to test hemoglobin levels prior to any surgery in order to prevent morbidity. The purpose of our study is to look at the prevalence of anemia in patient undergoing minor elective ambulatory sur- geries. Method: This was a cross sectional observational study conducted at tertiary care unit, Karachi, Pakistan. A total of 385 ASA-I (American Society of Anesthesiologist) and II patient’s age ranged 18 - 60 years, scheduled for day care surgical procedures were enrolled in the study. Results: Anemia was detected in 74 (19.2%) patients and its preva- lence was found to be higher in females and in patients above 50 years of age. However, the presence of anemia did not have any influence on the perioperative outcomes or management. Conclusion: The routine preoperative hemoglobin testing does not have any effect on the perioperative outcomes in asymptomatic patients who are planned for elective day care surgeries. Keywords: Hemoglobin; Anemia; Day Care Surgery 1. Introduction The pre-anesthetic evaluation is defined as the process of clinical assessment that precedes the delivery of anesthe- sia care for surgery and for non-surgical procedures. The ultimate goal of preoperative medical assessment is to reduce the morbidity associated with surgery and anes- thesia and to increase the quality and decrease the cost of perioperative care. It also serves the purpose of optimiz- ing patients for elective surgery and if necessary, imple- ments measures to prepare higher risk patients for sur- gery [1,2]. The pre-operative anesthesia evaluation comprises of comprehensive history, physical examination and labo- ratory tests [1]. The history should include a complete review of systems, medication history, surgical and an- esthetic history, history of allergies and functional status. The physical examination and laboratory tests should be focused on information gathered from the history [1-6]. Recent literature suggests that preoperative laboratory testing should be based on clinical examination rather than routine protocols [1-6]. Preoperative hemoglobin test or screening for anemia is included in most of the hospitals preoperative testing protocols in third world countries despite the fact that routine laboratory tests for all patients are not good screening device for diseases [3]. It is important to note that the Normal test values are arbitrarily defined as those occurring within two standard deviations from mean thereby insuring that five percent of healthy individuals who have a single screening test will have an abnormal result, as more tests are ordered, the likelihood of false positive tests increases. These un- expected abnormal results have very little impact on the anesthetic management if at all [4,6-9]. At our hospital, despite knowing the current interna- tional guidelines, we routinely order hemoglobin levels for all patients at the time of pre-anesthesia evaluation regardless of patient’s age and kind of surgery because the World Health Organization has identified that iron and folic acid deficiency is a severe problem in Pakistan and it has devastating impacts on health and survival [10]. The objective of our study was to determine the prevalence of anemia and to observe the impact of ane- mia in terms of case cancellation, case rescheduling, un- Copyright © 2012 SciRes. OJAnes