Military Patient Blood Management as a Critical Factor in Combat-Related Septic Reconstructive Surgery: A Case Report

Patient Blood Management (PBM) is an evidence-based, multidisciplinary strategy that aims to optimize hemoglobin levels, to minimize perioperative blood loss, and to reduce avoidable transfusions. In military medicine, combat-related traumatic injuries (CRTI) pose specific challenges, as wounded soldiers frequently develop multifactorial anemia because of acute and chronic blood loss, inflammation, malnutrition, and delayed access to care. Although blood transfusions are a common treatment, they carry medical risks and represent a scarce, logistically demanding resource, especially in deployed or resource-limited settings. This case report illustrates the importance of early anemia screening, differentiation, and targeted treatment with a PBM framework in septic reconstructive surgery. A 32-year-old Ukrainian soldier was admitted to the Emergency Department of the Military Hospital Berlin, Germany. Eight months ago, the soldier sustained a blast injury with a femoral fracture and stabilization by external fixation in his home country. Diagnostic work-up detected chronic osteomyelitis and previously untreated iron deficiency. During ongoing surgical and antimicrobial treatment, the anemia progressed postoperatively but was successfully managed with intravenous and oral iron supplementation, without the need for blood transfusion. This case highlights the importance of structured anemia management in military surgery, even in young and otherwise healthy patients, to improve clinical outcomes while preserving limited resources. This aspect is of relevance during large-scale combat operations with high numbers of casualties. In this context, anemia management relies on the simple identification of underlying causes and correction of deficiencies in iron, vitamin B12, or folate when present, offering an effective and easily applicable strategy before resorting to blood transfusion.