Iron & Folic Acid Before Plastic Surgery: Why Your Surgeon May Recommend Them

Preoperative iron and folic acid are often advised to optimize hemoglobin and reduce perioperative transfusion risk.

Rationale

• Iron: Essential for hemoglobin synthesis. Surgery blood loss → anemia risk. Pre-op repletion (oral 4–6 weeks or IV if severe/time short) raises Hb.
• Folic acid: Cofactor for erythropoiesis; prevents megaloblastic changes. Synergistic with iron.
• Evidence: Pre-op iron (especially IV) reduces transfusion in major surgery (cardiac, ortho, gynecologic).

Who Needs It

• Preoperative anemia (Hb <13 g/dL men, <12 g/dL women).
• High blood loss anticipated (>500 mL).
• History of anemia, menorrhagia, vegetarian/vegan, malabsorption.

Workup & Dosing

• CBC, ferritin, TSAT, B12, folate 4+ weeks pre-op.
• Oral: Ferrous sulfate 325 mg (65 mg elemental) × 1–2/day + vitamin C.
• IV iron (ferric carboxymaltose, iron sucrose) if ferritin <30, TSAT <20%, or <4 weeks to surgery.
• Folic acid 1 mg daily (higher if deficiency).

Coordination

Surgeon, anesthesiologist, and primary care/hematology should align on plan. Do not self-start without labs — iron overload is harmful.