Anemia Associated with Hip Fracture
The anemia occurring in hip fracture patients does not have a specific eponymous name, but is clinically characterized as perioperative anemia with both preoperative and postoperative components, often classified as anemia of chronic inflammation (also called anemia of chronic disease) when iron deficiency coexists with inflammatory states. 1
Classification and Pathophysiology
The anemia in hip fracture patients has multiple overlapping etiologies:
Preoperative anemia is present in 40-44% of hip fracture patients at admission, reflecting baseline chronic conditions, nutritional deficiencies, and the inflammatory response to trauma 1, 2
Postoperative anemia develops in 87-93% of patients following surgery, representing a combination of surgical blood loss, hemodilution, and ongoing inflammation 1, 2
Anemia of chronic inflammation (also termed anemia of chronic disease) is the most clinically relevant classification, occurring in 23-70% of cases where inflammation drives hepcidin elevation, which blocks iron absorption and sequesters iron in macrophages 1
Clinical Characteristics
The typical hemoglobin trajectory in hip fracture patients demonstrates:
Mean preoperative hemoglobin: 12.5 ± 0.2 g/dL 1
Mean postoperative hemoglobin: 8.2 ± 2.1 g/dL 1
Postoperative anemia prevalence: 87 ± 10% of patients 1
Diagnostic Terminology in Clinical Practice
When documenting this condition, use descriptive terminology rather than seeking a specific disease name:
"Perioperative anemia associated with hip fracture" captures both pre- and postoperative components 1, 2
"Anemia of chronic inflammation" or "anemia of chronic disease" when ferritin is elevated (>100 μg/L) with low transferrin saturation (<20%) in the postoperative inflammatory state 1, 4
"Acute blood loss anemia" for the immediate postoperative component related to surgical hemorrhage 5, 2
"Iron deficiency anemia" when ferritin <30 μg/L and/or transferrin saturation <20% without inflammation 4
Clinical Significance
This anemia pattern is clinically important because:
Mortality impact: Preoperative anemia is associated with increased short- and long-term mortality in hip fracture patients 5, 6
Functional outcomes: Early postoperative anemia (hemoglobin <10 g/dL) is an independent risk factor for inability to ambulate on postoperative day 3 (OR 0.41, P <0.002) 1
Hospital length of stay: Both preoperative and postoperative anemia correlate with prolonged hospitalization 6, 2
Transfusion requirements: 44 ± 15% of hip fracture patients require allogeneic blood transfusion 1
Common Pitfall
Do not simply label this as "postoperative anemia" without recognizing the preoperative component, as 40-44% of patients are already anemic at admission, and this baseline anemia independently predicts worse outcomes 1, 2. The inflammatory component driven by hepcidin makes oral iron therapy ineffective, requiring intravenous iron for treatment 1, 4.