{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T17:44:11Z","timestamp":1774892651181,"version":"3.50.1"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Johann Wolfgang Goethe-Universit\u00e4t, Frankfurt am Main"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Perioper Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>While intravenous iron improves outcomes in anaemic surgical patients, the impact of iron deficiency (ID) and its treatment in non-anaemic patients remains unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In this single-centre retrospective analysis, non-anaemic ID patients (age\u2009\u2265\u200918\u00a0years) undergoing major cardiac surgery at the University Hospital Frankfurt were included. Primary endpoints were red blood cell (RBC) transfusion rate and use of RBC units. Secondary endpoints were increase in haemoglobin levels and postoperative outcome (mortality, length of stay, mechanical ventilation, laboratory values). Patients were assigned to the following groups: No-Iron (no anaemia, ID, and no iron supplementation) and Iron (anaemia, ID, and iron supplementation).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 3605 patients were screened, of whom 2345 were non-anaemic. Six hundred ninety-eight non-anaemic ID patients were included in the analysis, of whom 90 received intravenous iron supplementation. The overall RBC transfusion rate (43.6% [95% CI: 39.6\u201347.6] versus 50.0% [95% CI: 39.9\u201360.1]) and number of transfused blood units (2.0 [IQR: 1.0; 4.0] versus 2.0 [IQR: 1.0; 4.0]) were similar between patients of the No-Iron and Iron groups. Hospital length of stay, mortality, and postoperative complications were similar in both groups. When applying stricter cutoff values to define ID (ferritin\u2009&lt;\u200930\u00a0\u03bcg\/l), a trend toward reduced transfusion rates was observed: total RBC transfusion rate was 50.0% (95% CI: 34.9\u201365.2) in the No-Iron group and 42.9% (95% CI: 26.8\u201360.5) in the Iron group. In the case of short-term (1\u00a0day prior to surgery) iron supplementation, RBC unit utilisation and postoperative outcomes were comparable between the two groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In non-anaemic cardiac surgery patients, (short-term) preoperative intravenous iron supplementation showed no significant impact on RBC transfusion rate, haemoglobin levels, or postoperative outcomes. However, a stricter definition of ID revealed a trend toward reduced transfusion rates.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13741-025-00596-8","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T10:43:02Z","timestamp":1760352182000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of (short-term) intravenous iron supplementation in iron-deficient non-anaemic cardiac surgical patients on perioperative outcome"],"prefix":"10.1186","volume":"14","author":[{"given":"Lea Valeska","family":"Blum","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nico","family":"Hipp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Neef","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anatol","family":"Prinzing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Zacharowski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Meybohm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suma","family":"Choorapoikayil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"issue":"4","key":"596_CR1","first-page":"520","volume":"12","author":"N Agnihotri","year":"2014","unstructured":"Agnihotri N, Pal L, Thakur M, Kumar P. The need to label red blood cell units with their haemoglobin content: a single centre study on haemoglobin variations due to donor-related factors. Blood Transfus. 2014;12(4):520\u20136.","journal-title":"Blood Transfus"},{"key":"596_CR2","unstructured":"Anemia Algorithm V04. 2025. Available from: https:\/\/www.patientbloodmanagement.de\/wp-content\/uploads\/2021\/04\/202103Anaemiemanagement_ENG.png."},{"issue":"25","key":"596_CR3","doi-asserted-by":"publisher","first-page":"2436","DOI":"10.1056\/NEJMoa0908355","volume":"361","author":"SD Anker","year":"2009","unstructured":"Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361(25):2436\u201348.","journal-title":"N Engl J Med"},{"issue":"5","key":"596_CR4","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.healun.2021.01.1390","volume":"40","author":"KV Brautaset Englund","year":"2021","unstructured":"Brautaset Englund KV, \u00d8stby CM, Rolid K, Gude E, Andreassen AK, Gullestad L, et al. Intravenous iron supplement for iron deficiency in cardiac transplant recipients (IronIC): a randomized clinical trial. J Heart Lung Transplant off Publ Int Soc Heart Transplant. 2021;40(5):359\u201367.","journal-title":"J Heart Lung Transplant off Publ Int Soc Heart Transplant"},{"key":"596_CR5","unstructured":"Bundes\u00e4rztekammer, (ed). Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. K\u00f6ln: Deutscher \u00c4rzteverlag; 2009\u00a0p 272 . Available from:https:\/\/www.bundesaerztekammer.de\/fileadmin\/user_upload\/_old-files\/downloads\/QLL_Haemotherapie_2014.pdf."},{"key":"596_CR6","doi-asserted-by":"publisher","unstructured":"Bundes\u00e4rztekammer, (ed). Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten: Gesamtnovelle; 2020. Deutscher \u00c4rzteverlag; 2021. Available from:https:\/\/www.beck-elibrary.de\/index.php?. https:\/\/doi.org\/10.47420\/9783769137309. Cited 2025 June 11.","DOI":"10.47420\/9783769137309"},{"key":"596_CR7","doi-asserted-by":"crossref","unstructured":"Cacoub P, Choukroun G, Cohen-Solal A, Luporsi E, Peyrin-Biroulet L, Peoc\u2019h K, et al. Iron deficiency screening is a key issue in chronic inflammatory diseases: a call to action. J Intern Med. 2022;292(4):542\u201356.","DOI":"10.1111\/joim.13503"},{"key":"596_CR8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2022.111009","volume":"84","author":"F Corsi","year":"2023","unstructured":"Corsi F, Pasquini A, Guerrera M, Bevilacqua F, Taccheri T, Antoniucci ME, et al. Single shot of intravenous iron in cardiac surgery: the ICARUS study. J Clin Anesth. 2023;84:111009.","journal-title":"J Clin Anesth"},{"issue":"6","key":"596_CR9","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1016\/j.bja.2023.09.007","volume":"131","author":"T Friedman","year":"2023","unstructured":"Friedman T, Dann EJ, Bitton-Worms K, Makhoul M, Glam R, Weis A, et al. Intravenous iron administration before cardiac surgery reduces red blood cell transfusion in patients without anaemia. Br J Anaesth. 2023;131(6):981\u20138.","journal-title":"Br J Anaesth"},{"issue":"3","key":"596_CR10","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jacbts.2019.08.009","volume":"5","author":"K Ghafourian","year":"2020","unstructured":"Ghafourian K, Shapiro JS, Goodman L, Ardehali H. Iron and heart failure: diagnosis, therapies, and future directions. JACC Basic Transl Sci. 2020;5(3):300\u201313.","journal-title":"JACC Basic Transl Sci"},{"key":"596_CR11","doi-asserted-by":"crossref","unstructured":"Grote Beverborg N, Klip IjT, Meijers WC, Voors AA, Vegter EL, van der Wal HH, et al. Definition of iron deficiency based on the gold standard of bone marrow iron staining in heart failure patients. Circ Heart Fail. 2018;11(2):e004519.","DOI":"10.1161\/CIRCHEARTFAILURE.117.004519"},{"issue":"9","key":"596_CR12","doi-asserted-by":"publisher","first-page":"1899","DOI":"10.1053\/j.jvca.2024.05.039","volume":"38","author":"CGA Horwood","year":"2024","unstructured":"Horwood CGA, Patel ND, Walker JD, Evans CR. Nonanemic iron deficiency in cardiac surgery: a retrospective observational study. J Cardiothorac Vasc Anesth. 2024;38(9):1899\u2013906.","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"6","key":"596_CR13","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1016\/j.bja.2024.08.030","volume":"133","author":"KC Hung","year":"2024","unstructured":"Hung KC, Chang LC, Ho CN, Hsu CW, Yu CH, Wu JY, et al. Efficacy of intravenous iron supplementation in reducing transfusion risk following cardiac surgery: an updated meta-analysis of randomised controlled trials. Br J Anaesth. 2024;133(6):1137\u201349.","journal-title":"Br J Anaesth"},{"issue":"1","key":"596_CR14","doi-asserted-by":"publisher","first-page":"36","DOI":"10.4103\/gjtm.gjtm_56_21","volume":"7","author":"R Jain","year":"2022","unstructured":"Jain R, Sachdev S, Marwaha N, Gupta A. Assessment of hemoglobin content of packed red cells: a prospective study on hemoglobin content variation due to donor, collection, and processing-related factors. Is it time to label each unit with hemoglobin content? Global Journal of Transfusion Medicine. 2022;7(1):36.","journal-title":"Global Journal of Transfusion Medicine"},{"issue":"5","key":"596_CR15","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1111\/anae.15681","volume":"77","author":"HB Kim","year":"2022","unstructured":"Kim HB, Shim JK, Ko SH, Kim HR, Lee CH, Kwak YL. Effect of iron deficiency without anaemia on days alive and out of hospital in patients undergoing valvular heart surgery. Anaesthesia. 2022;77(5):562\u20139.","journal-title":"Anaesthesia"},{"issue":"23","key":"596_CR16","first-page":"00757","volume":"S2213\u20131779","author":"P Martens","year":"2023","unstructured":"Martens P, Augusto SN, Mullens W, Tang WHW. Meta-analysis and metaregression of the treatment effect of intravenous iron in iron-deficient heart failure. JACC Heart Fail. 2023;S2213\u20131779(23):00757\u201366.","journal-title":"JACC Heart Fail"},{"key":"596_CR17","first-page":"140","volume":"61","author":"P Meybohm","year":"2020","unstructured":"Meybohm P, Schnitzbauer A, Bechstein WO, Schmitz-Rixen T, Marzi I, Lustenberger T, et al. Automatized OPS-based calculation of likelihood of RBC concentrate transfusion in a hospital. An\u00e4sth Intensiv. 2020;61:140\u201353.","journal-title":"An\u00e4sth Intensiv"},{"key":"596_CR18","doi-asserted-by":"crossref","unstructured":"Meybohm P, Schmitt E, Choorapoikayil S, Hof L, Old O, M\u00fcller MM, et al. German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients. Br J Anaesth. 2023;131(3):472\u201381.","DOI":"10.1016\/j.bja.2023.05.006"},{"issue":"7","key":"596_CR19","doi-asserted-by":"publisher","first-page":"e514","DOI":"10.1016\/S2352-3026(22)00142-9","volume":"9","author":"LF Miles","year":"2022","unstructured":"Miles LF, Pac Soo V, Braat S, Bade-Boon J, Heritier S, Klein AA, et al. Associations between non-anaemic iron deficiency and outcomes following elective cardiac surgery (IDOCS): a prospective cohort study. Lancet Haematol. 2022J;9(7):e514\u201322.","journal-title":"Lancet Haematol"},{"issue":"3","key":"596_CR20","first-page":"370","volume":"13","author":"M Mu\u00f1oz","year":"2015","unstructured":"Mu\u00f1oz M, G\u00f3mez-Ram\u00edrez S, Campos A, Ruiz J, Liumbruno GM. Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus. 2015July;13(3):370\u20139.","journal-title":"Blood Transfus"},{"issue":"2","key":"596_CR21","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1111\/anae.13773","volume":"72","author":"M Mu\u00f1oz","year":"2017","unstructured":"Mu\u00f1oz M, Acheson AG, Auerbach M, Besser M, Habler O, Kehlet H, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72(2):233\u201347.","journal-title":"Anaesthesia"},{"issue":"11","key":"596_CR22","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1016\/j.cardfail.2010.05.009","volume":"16","author":"CJ Murphy","year":"2010","unstructured":"Murphy CJ, Oudit GY. Iron-overload cardiomyopathy: pathophysiology, diagnosis, and treatment. J Card Fail. 2010;16(11):888\u2013900.","journal-title":"J Card Fail"},{"issue":"1","key":"596_CR23","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1213\/ANE.0000000000006822","volume":"139","author":"V Peri","year":"2024","unstructured":"Peri V, Devlin P, Perry L, Richards T, Miles LF. Associations between nonanemic iron deficiency and postoperative outcomes in cardiac surgery: a systematic review and meta-analysis. Anesth Analg. 2024;139(1):47\u201357.","journal-title":"Anesth Analg"},{"issue":"11","key":"596_CR24","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1097\/EJA.0b013e32834ad97b","volume":"28","author":"P Piednoir","year":"2011","unstructured":"Piednoir P, Allou N, Driss F, Longrois D, Philip I, Beaumont C, et al. Preoperative iron deficiency increases transfusion requirements and fatigue in cardiac surgery patients: a prospective observational study. Eur J Anaesthesiol. 2011;28(11):796\u2013801.","journal-title":"Eur J Anaesthesiol"},{"issue":"1","key":"596_CR25","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.bja.2019.09.016","volume":"124","author":"J R\u00f6ssler","year":"2020","unstructured":"R\u00f6ssler J, Schoenrath F, Seifert B, Kaserer A, Spahn GH, Falk V, et al. Iron deficiency is associated with higher mortality in patients undergoing cardiac surgery: a prospective study. Br J Anaesth. 2020;124(1):25\u201334.","journal-title":"Br J Anaesth"},{"issue":"2","key":"596_CR26","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1097\/SLA.0000000000005011","volume":"275","author":"JW Song","year":"2022","unstructured":"Song JW, Soh S, Shim JK, Lee S, Lee SH, Kim HB, et al. Effect of perioperative intravenous iron supplementation for complex cardiac surgery on transfusion requirements: a randomized, double-blinded placebo-controlled trial. Ann Surg. 2022;275(2):232\u20139.","journal-title":"Ann Surg"},{"issue":"10187","key":"596_CR27","doi-asserted-by":"publisher","first-page":"2201","DOI":"10.1016\/S0140-6736(18)32555-8","volume":"393","author":"DR Spahn","year":"2019","unstructured":"Spahn DR, Schoenrath F, Spahn GH, Seifert B, Stein P, Theusinger OM, et al. Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial. Lancet. 2019;393(10187):2201\u201312.","journal-title":"Lancet"},{"key":"596_CR28","doi-asserted-by":"crossref","unstructured":"Triphaus C, Judd L, Glaser P, Goehring MH, Schmitt E, Westphal S, et al. Effectiveness of preoperative iron supplementation in major surgical patients with iron deficiency: a prospective observational study. Ann Surg. 2021;274(3):e212\u20139.","DOI":"10.1097\/SLA.0000000000003643"},{"issue":"3","key":"596_CR29","first-page":"532","volume":"51","author":"ME van Vessem","year":"2017","unstructured":"van Vessem ME, Palmen M, Couperus LE, Mertens B, Berendsen RR, Tops LF, et al. Incidence and predictors of vasoplegia after heart failure surgery. Eur J Cardio-Thorac Surg off J Eur Assoc Cardio-Thorac Surg. 2017;51(3):532\u20138.","journal-title":"Eur J Cardio-Thorac Surg off J Eur Assoc Cardio-Thorac Surg"},{"issue":"3","key":"596_CR30","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1097\/MOH.0000000000000236","volume":"23","author":"CY Wang","year":"2016","unstructured":"Wang CY, Babitt JL. Hepcidin regulation in the anemia of inflammation. Curr Opin Hematol. 2016;23(3):189\u201397.","journal-title":"Curr Opin Hematol"},{"key":"596_CR31","unstructured":"WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations [Internet]. Geneva: World Health Organization; 2020. (WHO Guidelines approved by the Guidelines Review Committee). Available from:\u00a0http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK569880\/.\u00a0Cited 2024 Oct 27."},{"issue":"8","key":"596_CR32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0201153","volume":"13","author":"C Wittkamp","year":"2018","unstructured":"Wittkamp C, Traeger L, Ellermann I, Eveslage M, Steinbicker AU. Hepcidin as a potential predictor for preoperative anemia treatment with intravenous iron-a retrospective pilot study. PLoS ONE. 2018;13(8):e0201153.","journal-title":"PLoS ONE"}],"container-title":["Perioperative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13741-025-00596-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13741-025-00596-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13741-025-00596-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T10:43:17Z","timestamp":1760352197000},"score":1,"resource":{"primary":{"URL":"https:\/\/perioperativemedicinejournal.biomedcentral.com\/articles\/10.1186\/s13741-025-00596-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,13]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["596"],"URL":"https:\/\/doi.org\/10.1186\/s13741-025-00596-8","relation":{},"ISSN":["2047-0525"],"issn-type":[{"value":"2047-0525","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,13]]},"assertion":[{"value":"17 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the local Ethics Committee of the University Hospital Frankfurt (approved December 17, 2012, Ref. 318\/17). Informed consent was waived for this study. All the ethical principles for medical investigation in human beings recorded in the Helsinki Declaration of the World Medical Association were followed.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and\u00a0consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"107"}}