Adjunctive Intravenous Iron and Early Hematologic Recovery after Gynecologic Surgery

Postoperative hemorrhage following gynecologic surgery may require packed red blood cell (PRBC) transfusion, particularly in patients with pre-existing anemia related to chronic gynecologic blood loss. The role of adjunctive intravenous iron therapy in early postoperative hematologic recovery remains insufficiently defined.

To evaluate the association between adjunctive intravenous ferric carboxymaltose and early hematologic recovery in gynecologic patients requiring PRBC transfusion for postoperative hemorrhage.

This retrospective cohort study included 119 patients with postoperative hemorrhage requiring PRBC transfusion after gynecologic surgery. Patients were grouped according to management with PRBC transfusion alone (n=53) or PRBC transfusion plus adjunctive intravenous ferric carboxymaltose (n=66). Hemoglobin, reticulocyte count and red cell distribution width (RDW) were assessed during the first postoperative week. Multivariable linear regression was used to identify factors independently associated with postoperative day 7 hemoglobin concentration and logistic regression was used to assess factors associated with transfusion requirement of ≥two PRBC units.

Patients receiving adjunctive ferric carboxymaltose had lower baseline hemoglobin levels (8.94±1.18 vs. 9.50 ±1.31 g/dL, p= 0.003) and more frequent acute anemia at admission (78.8% vs. 58.5%, p=0.028). At postoperative day 7, hemoglobin concentration was significantly higher in the intravenous iron group (9.11±0.84 vs. 8.15 ± 0.91 g/dL, p < 0.001). After adjustment for baseline hemoglobin, acute anemia and age, adjunctive intravenous iron remained independently associated with higher postoperative day 7 hemoglobin concentration (B=1.228, 95% CI 0.915-1.540, p<0.001). Reticulocyte counts were also higher in the intravenous iron group (2.28±0.67% vs. 1.18±0.42%, p<0.001). Intravenous iron was not independently associated with transfusion requirement of ≥two PRBC units.

Adjunctive intravenous ferric carboxymaltose was independently associated with improved early hematologic recovery after PRBC transfusion for postoperative hemorrhage in gynecologic patients, without reducing immediate transfusion requirements. These findings support its role as a complementary postoperative patient blood management strategy after hemorrhage control and clinical stabilization. Given the retrospective observational design, the results should be interpreted as associations rather than evidence of causality.