Optimizing Preoperative Haematocrit in Anaemic Patients Refusing Allogenic Blood Transfusion: A Critical Review of Clinical Methods and Strategies

Abstract

Preoperative anemia is a significant challenge in patients refusing allogenic blood transfusion. Anemia is a prevalent condition among surgical patients and optimizing preoperative hematocrit or packed cell volume (PCV) is crucial to minimize perioperative complications. However, some patients refuse allogenic blood transfusions due to various reasons, including religious beliefs, fear of transfusion-related complications, or concerns about blood-borne infections. This review aims to evaluate the evidence supporting various clinical methods and strategies for optimizing preoperative haematocrit in these patients. This review also aims to identify effective clinical methods and strategies for optimizing preoperative hematocrit or PCV in anemic patients undergoing surgery who refuse allogenic blood transfusion.  A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Web of Science, to identify relevant studies published between 2020 and 2025 in order to make a classification list of the various pharmaceutical and non-pharmaceutical agents and their standardized acceptable clinical methods and strategies used for optimizing preoperative hematocrit or packed cell volume (PCV) in anemic patients undergoing surgery refusing allogenic blood transfusion. The review highlights the importance of preoperative anemia management, including the use of erythropoiesis-stimulating agents, iron supplementation, tranexamic acid and optimization of underlying chronic diseases and etc. The findings of this review will provide healthcare professionals with evidence-based strategies to optimize preoperative hematocrit or PCV in anemic patients refusing allogenic blood transfusion, ultimately improving surgical outcomes and patient safety. Key findings include Iron supplementation and erythropoietin stimulating agents (ESAs) are effective in increasing haemoglobin levels and reducing transfusion requirements in preoperative anemia. Hypoxia-inducible factor (HIF) stabilizers show promise in increasing haemoglobin levels, but more research is needed to confirm their safety and efficacy. Multidisciplinary teams and institutional policies are essential for managing patients refusing blood transfusion. Conclusively, optimizing preoperative haematocrit in anaemic patients refusing allogenic blood transfusion requires a multidisciplinary approach. Evidence-supported practices such as iron supplementation and ESAs can be effective, while emerging strategies like intravenous ferric carboxymaltose and HIF stabilizers show promise. Healthcare providers must be aware of the medico-legal aspects of treating these patients and respect their autonomy.