Post-operative Intravenous Iron to Treat Iron-deficiency Anemia in Patients Undergoing Cardiac Surgery

Inclusion criteria

Patients who are undergoing any non-emergency open cardiac surgery and who meet all following criteria:

• Age greater than 18 years old
• Preoperative iron-deficiency with or without anemia (defined as Hb <130 g/L) with any one of:

• ferritin ≤100 μg/l; or
• ferritin ≤ 300 μg/L and transferrin saturation ≤ 20%; or
• reticulocyte Hb content < 29 pg, where available

Exclusion criteria

Patients who meet any of the following criteria are not eligible for the study:

• specialized procedures (e.g., ventricular assist device insertion, thoracoabdominal aneurysm, complex adult congenital surgery and heart transplant)
• established contraindications to IV iron:

• hypersensitivity to the iron product
• history of >2 food and/or drug allergic reactions (excluding drug intolerance)
• non-iron deficiency anemias such as myelodysplastic syndrome
• history of iron overload or disturbances in use of iron such as hemochromatosis or hemosiderosis
• decompensated liver cirrhosis (MELD ≥ 19) or active hepatitis
• active infection
• preoperative unstable hemodynamics defined as the requirement for vasopressors or inotropes, or active bleeding (as noted in the clinical record and/or defined as a requirement for red blood cell transfusion for ongoing clinical bleeding)
• refusal of blood products for religious or other reasons
• known pregnancy
• already enrolled in this trial
• enrolment in another interventional trial which may impact anemia or transfusion management (for example, a trial of hemostatic therapies, such as tranexamic acid)
• receipt of intravenous iron at any point in the 6 weeks prior to randomization