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Updated: Jan 7, 2026

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Hemoglobin Optimization and Transfusion Reduction Through Anemia and Iron Deficiency Correction: A Post Hoc

Hélène Charbonneau1, Marie Pasquié2, Nicolas Savy3

  • 1Department of Anesthesiology and Intensive Care Unit, Clinique Pasteur, Toulouse, France.

Journal of Cardiothoracic and Vascular Anesthesia
|January 3, 2026
PubMed

Insights

Systematic correction of anemia and iron deficiency (ID) before surgery significantly boosts hemoglobin levels. This approach also substantially reduces the need for red blood cell transfusions in patients undergoing cardiac surgery.

Area of Science:

  • Cardiology
  • Hematology
  • Anesthesiology

Background:

  • Anemia and iron deficiency (ID) are prevalent in patients undergoing cardiac surgery.
  • These conditions can lead to increased transfusion requirements and adverse outcomes.

Purpose of the Study:

  • To evaluate the impact of systematic perioperative anemia and/or ID correction on hemoglobin (Hb) levels.
  • To assess the effect of this intervention on red blood cell (RBC) transfusion rates in elective cardiac surgery patients.

Main Methods:

  • A post hoc analysis of a prospective, non-randomized, before-and-after study was conducted.
  • The intervention involved systematic screening and treatment for anemia/ID using intravenous iron and erythropoietin-α.
  • Propensity-score overlap weighting and multiple imputation were used for adjustments.

Main Results:

  • Hb levels significantly increased in anemic patients (+1.8 g/dL, p < 0.001).
  • RBC transfusion rates were significantly reduced in anemic patients with ID (26.1% vs 55.9%, p = 0.003) and without ID (17.4% vs 55.3%, p = 0.007).
  • No significant differences in outcomes or mortality were observed.

Conclusions:

  • Systematic correction of anemia and/or ID is effective in improving Hb levels.
  • This strategy significantly reduces transfusion needs in elective cardiopulmonary bypass surgery.
  • The findings support the integration of this approach into perioperative patient blood management protocols.
Abstract

Keywords:
blood transfusioncardiac surgeryerythropoietinhemoglobiniron deficiencypatient blood managementperioperative outcomespreoperative anemia

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