Feasibility of a Multidisciplinary IV Iron Pathway for Women with Iron Deficiency Anemia Undergoing Gynecologic...

Iron deficiency anemia (IDA) is a common cause of perioperative morbidity among women and individuals with a uterus undergoing gynecologic surgery, particularly those with abnormal uterine bleeding (AUB). Although intravenous (IV) iron is a safe and effective alternative to red blood cell (RBC) transfusion, IDA often remains underrecognized and undertreated. The Impact of Iron Supplementation on Transfusion in Women Undergoing Gynecologic Procedures (STRONG) pilot study evaluated the feasibility of implementing a multidisciplinary IV iron pathway for patients with IDA awaiting gynecologic surgery.

This prospective, single-centre cohort study was conducted between June 2022 and March 2025. Eligible patients were adults with laboratory-confirmed IDA (ferritin <30 μg/L or transferrin saturation <20%; and hemoglobin <120 g/L) scheduled for elective gynecologic surgery at least 4 weeks after diagnosis who had failed or were intolerant of oral iron. A multidisciplinary pathway integrating patient blood management (PBM) principles was developed for identifying and managing preoperative IDA. Primary outcomes were recruitment feasibility and pathway implementation feasibility, assessed by protocol adherence and IV iron delivery. Exploratory clinical measures included patient demographics, laboratory values, surgical details, transfusion rates, and perioperative outcomes.

Twenty patients consented to study participation. Protocol adherence and IV iron delivery were 100%. Median hemoglobin increased from 93 g/L to 121 g/L preoperatively. Six patients (30%) required perioperative transfusion.

Implementation of a multidisciplinary IV iron pathway for the detection and management of preoperative IDA in gynecologic surgery was feasible, supporting the integration of PBM strategies into routine perioperative care.