Introduction Preoperative anaemia is a strong predictor of blood transfusion requirement. Patient Blood Management guidelines highlight the need for preoperative anaemia assessment and management in order to optimise haemoglobin prior to elective surgery. However, there is no randomised control trial elucidating the clinical effectiveness of the type of iron preparation that should be used preoperatively. The main objective of this study is to compare the efficacy of intravenous ferric carboxymaltose (Ferinject) therapy and oral iron on pre-operative haemoglobin levels in anaemic patients undergoing elective cardiac surgery.

Method 50 anaemic patients who were listed for elective cardiac surgery were recruited preoperatively and randomised to receive either oral iron (ferrous sulphate) or intravenous iron (ferric carboxymaltose). Change in haemoglobin level after an intervention was measured and data were collected on blood transfusion use and postoperative outcomes. Comparisons of continuous variables were performed using the t-test for normally distributed variables and the Mann-Whitney U test for skewed distributions. Comparisons of categorical variables were performed using chi-square test.

Results There were no differences in the baseline clinical, demographic characteristics and surgical procedures between the two groups. The median rise in haemoglobin is higher in the oral iron group (3.5 g/L; p=

0.72) compared to intravenous group (2 g/L) but was not statistically significant. The first 12 hour blood loss was high in the intravenous group (median 655 (IQR 162–1540) ml versus 312.5 (150–1750) ml in oral iron group ml; p=0.007). There were no comparable differences observed in post operative outcomes but the mean transfusion was more in the intravenous group (2.6 vs 1.8, p=0.1). At surgery, intravenous group had higher ferritin levels than oral group (median 392 µg/L vs 49) µg/l; p<0.0001)

Conclusion Intravenous iron was not effective in improving preoperative haemoglobin after elective cardiac surgery and did not reduce blood transfusion requirements. Moreover, intravenous iron appears to significantly increase the risks of intraoperative bleeding. Larger randomised controlled trials are needed examining the effect of intravenous iron on preoperative anaemia and subsequent outcome after cardiac surgery.

Disclosure of Interest H Padmanabhan: None Declared, K Siau: None Declared, A Nevill: None Declared, H Luckraz: None Declared, MJ Brookes Conflict with: Vifor Pharma