Blood transfusion really necessary?

Question

I am scheduled to have a mini TT and hysterectomy simultaneously in 12 days. My hemogloblin level is 9.6. I am an American, but I am currently living in Italy. The hospital here wants me to do a blood transfusion. With my hemoglobin level at 9.6, and I only started taking iron supplements 4 days ago, does this seem premature?

Gerald Minniti, MD, FACS · Answer

There have been a multitude of scientific papers written about cosmetic surgery and deliveries, and the bottom line is its not safe and leads to less than satisfactory results. Just deliver your baby and get what you will likely need later, a full tummy tuck.

J. Timothy Katzen, MD, FACS · Answer

Hello and thank you for your question regarding the necessity of a blood transfusion with a hemoglobin level of 9.6, especially in the context of your upcoming mini tummy tuck and hysterectomy in Italy.

In the United States, most plastic surgeons would not typically recommend a transfusion for a hemoglobin level of 9.6. However, medical practices can vary significantly between countries, and it appears that the standards in Italy might be different. Each country and its medical professionals often have different criteria for when a transfusion is necessary.

It's important to consider that the recommendation for a blood transfusion may not be solely due to the mini tummy tuck but rather in anticipation of the potential significant blood loss associated with the hysterectomy. Hysterectomies, depending on their complexity, can lead to considerable blood loss, which might necessitate a transfusion either during or after the procedure.

Personally, I would advise waiting until a transfusion is absolutely necessary. This decision can often be made intraoperatively or immediately postoperatively based on real-time assessments of your blood levels and overall stability during the surgery.

Since you have started taking iron supplements only recently, it's also possible that your hemoglobin levels may improve slightly before your surgery, which could further influence the need for a transfusion.

I recommend discussing these concerns in detail with your surgical team in Italy, ensuring they explain their protocols and rationale clearly. Understanding their perspective will help you feel more comfortable with the care you receive.

Good luck with your upcoming procedures, and I hope this response has helped clarify your question regarding the necessity of a blood transfusion under your specific circumstances.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Tyler Frew, MD · Answer

Hi there,
You don't have enough time for the iron supplements to kick in unfortunately, it usually takes a few months to see. We usually like to have patients hbg around 10.0 before operating so that is likely the reason they want a transfusion. 
I would say the transfusion is low risk and will help you recover better after surgery. 
All the best

Ronald J. Edelson, MD · Answer

In many cases you can donate your own blood several weeks prior to surgery so you can be sure to get back your own blood if needed. You should look into that as an option

Manuel Diaz, MD · Answer

Hello dear. A hemoglobin level of 9.6 g/dL is below the normal range for adults, which is usually 12-15 g/dL for women. This indicates anemia, which can increase the risk of complications during surgery, such as problems with oxygenation or postoperative recovery. Although taking iron is essential to increase your hemoglobin level, since surgery is significant and your hemoglobin level is below normal, blood transfusion before the operation is not premature. Transfusion can help reduce the risks associated with surgery and improve your ability to recover afterward. 
You can write to us at 829-554-6062 to give you all the necessary recommendations for the surgery.

Camille Cash, MD · Answer

More information is needed to determine if a blood transfusion is recommended for you.  What is the underlying cause of your low hemoglobin? You need to have a meeting with your surgeon to discuss your concerns and learn more about your options.  The supplements will take too long to increase the hemoglobin which is likely why the transfusion was recommended.

Connie Hiers, MD, FACS · Answer

You are anemic and the iron will not be able to raise your level that quickly. Blood is a precaution since some blood loss is expected with both procedures.  Perhaps after your hysterectomy, you will back up to normal levels.

Mats Hagstrom, MD (license on probation) · Answer

Transfusing somebody before surgery with a hemoglobin of 9.6 seems pretty extreme in my opinion.
I don’t know what community standards are in Italy for these issues.Some blood loss in surgery is inevitable.
There are many steps surgeons can take to minimize blood loss during surgery.
Injecting, lidocaine with epinephrine and giving this medication sufficient time to create a vasoconstriction (about 15minutes) is one excellent way of minimizing blood loss.
I told to avoid making medical decisions without having full context.
A young healthy person can tolerate significant anemia, and still be safe.
The same may not be true for someone with less reserve.
Taking iron may not increase Hemoglobin unless your iron deficient.
I suggest if you talk to your providers.
Best,
Mats Hagstrom, MD

Blood transfusion really necessary?

Answers (8)