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Goodnough et al¹ are to be commended for drawing attention to the impressive body of literature that documents the deleterious direct effects of anemia. Admittedly, anemia is ubiquitous and undertreated. However, the authors' statement that currently existing perisurgical transfusion guidelines "may misguide clinicians and underserve patients"¹ is not substantiated. Most studies they reference examined patients with progressive chronic medical conditions such as malignancy, congestive heart failure, and renal failure and are not applicable to surgical patients, a substantial percentage of whom are acutely ill. Of note, the study² they allude to that "suggests . . . mild anemia may be an independent risk factor for death following general surgery"¹ did not explicitly characterize patients by severity of illness, was observational in design, and does not address whether measures implemented to correct the anemia would impact any increased risk. The last point is of particular import, for while there is certainly . . . [Full Text of this Article]

William L. Jackson, Jr, MD
Washington, DC

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