The postoperative use of intravenous ferric carboxymaltose may be a strategy to curb the risk of iron-deficiency anemia in patients following major surgery. This is according to the results of a recent study conducted by researchers in Romania that was published in the Journal of Critical Care Medicine.

“In surgical patients, preoperative anaemia has a prevalence of approximately 40% of patients, reaching 90% after major surgeries,” the authors of the study wrote in their report. Anemia related to iron deficiency, they explained, is often linked to loss of blood volume with surgery or hospitalization. The researchers undertook this study to examine whether postoperative intravenous iron supplementation can positively impact hemoglobin status, in addition other laboratory parameters.

This prospective study evaluated adult patients undergoing major surgery associated with significant bleeding at the Emergency Clinical Hospital of Bucharest, Romania. Included patients were required to have had perioperative bleeding of >500 mL, or >250 mL if moderate or worse anemia was present before surgery. Patients also needed to have had postoperative iron deficiency screening and postoperative anemia. Multiple hematologic and other laboratory parameters were measured during screening. The primary study outcome was restoration of iron stores for improvement of erythropoiesis to quickly restore hemoglobin levels.

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A total of 21 patients were eligible for study inclusion. They had a mean age of 58.90 years and were mostly male (62%). Slightly over half (52.58%) of surgeries were emergency surgeries, while 47.61% were elective. All 21 patients were determined to have iron deficiency based on iron deficiency screening.

Ferric carboxymaltose was administered within 48 hours after surgery to 13 patients at a dosage of 1000 mg and to 3 patients at a dosage of 500 mg. Remaining patients received 500 mg or 1000 mg of ferric carboxymaltose at later intervals, at 3 to 5 days after surgery or after 7 days. Use of ferric carboxymaltose reportedly did not lead to adverse events in this study population.

Hemoglobin levels appeared to decrease in this population across preoperative (mean 11.78 g/dL) and intraoperative (mean 10.27 g/dL) measurements, and at the last measurement prior to iron administration (mean 8.51 g/dL). After iron administration, hemoglobin levels began to increase slightly. Between 48 hours and 72 hours after iron administration, the mean hemoglobin levels were 8.65 g/dL and 8.84 g/dL, respectively.

Elevated glycemia also appeared to be present in patients to a degree that was correlated with the correction of hemoglobin (P <.0001). The researchers reported that this also may have limited the rise in hemoglobin levels in the time period of analysis. 

“Our patients, who received intravenous iron treatment with ferric carboxymaltose, showed a favourable haemoglobin correction trend,” the study authors concluded in their report.


Tiglis M, Cibilinschi C, Mirea LE, et al. The importance of iron administration in correcting anaemia after major surgery. J Crit Care Med (Targu Mures). 2021;7(3):184-191. doi:10.2478/jccm-2021-0028