Treatment and long-term management of perioperative anemia in abnormal uterine bleeding

JIANG Xiao-lin; YANG Xin

doi:10.19538/j.fk2025100105

Abstract：Abnormal Uterine Bleeding(AUB)is the leading cause of anemia in women of reproductive age.Perioperative anemia associated with AUB significantly increases surgical risks and adversely affects patient outcomes.Therefore,a systematic perioperative blood management protocol is crucial.This includes:Preoperatively,make clear the etiology based on the FIGO PALM-COEIN classification system and assess the severity and type of anemia through laboratory investigations(routine blood test,iron metabolism,etc.);for acute AUB,rapid stabilization of vital signs,correction of coagulopathy,and iron replenishment(or transfusion if indicated)are priorities;for chronic AUB,scheduling elective surgery along with vigorous anemia correction is necessary(oral iron is suitable for 4-8 weeks before operation,while intravenous iron,particularly third-generation agents like ferric derisomaltose,offers faster efficacy and better tolerance.Intraoperatively,minimally invasive techniques should be prioritized along with meticulous haemostasis,continuous blood loss monitoring,and blood conservation strategies(e.g.cell salvage),and allogeneic transfusion should be reserved for cases meeting strict criteria.Postoperatively,close monitoring,preventing bleeding and continued anemia correction are essential.Long-term management aims to prevent recurrence,focusing on controlling bleeding through surgery or medical therapies[e.g.Levonorgestrel-Releasing Intrauterine System(LNG-IUS),hormonal treatments]tailored to the underlying causes.This is combined with a full course of iron therapy to replenish stores,nutritional intervention,lifestyle modifications,regular follow-up monitoring,and patient education.A multidisciplinary approach is employed when necessary to achieve effective menstrual control,prevent anemia recurrence,and ultimately improve patient prognosis and quality of life.