The Iron Clinic calls for anaemia to be identified and treated routinely before surgery, and for NICE guidance to reflect the new evidence
London: The largest clinical trial yet to examine intravenous (IV) iron for anaemia before cardiac surgery has found that a single infusion can reduce patients’ need for red-cell transfusion and improve recovery after surgery.
Published today in The BMJ, the international ITACS randomised controlled trial involved 955 adults across 33 hospitals in 10 countries. Patients with anaemia awaiting elective cardiac surgery received either 1,000 mg of IV iron or placebo between one and 26 weeks before surgery.
Patients receiving IV iron had more days alive and out of hospital during the 90 days after surgery: a median of 81.1 days compared with 80.0 days for placebo. The proportion receiving a red-cell transfusion fell from 68.2% to 61.1%. The researchers estimate that treating 100 patients saved approximately 44 units of blood products.
The treatment was also well tolerated, with no evidence of an increase in serious adverse events. The findings show that preoperative anaemia is a modifiable risk factor and that IV iron can form part of a practical patient blood-management pathway.
A timely finding for patients and health systems
Anaemia affects around one in three people undergoing cardiac surgery. It is associated with a greater likelihood of transfusion, complications, intensive-care use and longer hospital stays. Blood transfusion remains essential and lifesaving, but donated blood is finite and should be used where it is most clinically necessary.
The ITACS findings arrive as blood systems face renewed pressure. Recent warnings have highlighted summer shortages of red cells internationally and Europe’s vulnerability through its reliance on imported plasma. Improving the detection and treatment of anaemia before planned surgery will not replace the need for blood donation, but it can reduce avoidable demand and help make supplies more resilient.
For the NHS, this offers a rare combination: better preparation for surgery, improved recovery for patients, fewer transfusions and more efficient use of scarce hospital and blood-bank capacity.
Call for NICE guidance and routine NHS practice to change
Current NICE blood guidance recommends oral iron for iron-deficiency anaemia and when this fails, referral to specialist clinics. However, in a struggling NHS these ‘specialist clinics’ are not routine and where in existence the demand is significant, often with long delays.
Whereas in Australia, the use of IV iron is routine in primary care. The Iron Clinic believes ITACS provides strong new evidence for NICE to review this position, alongside the wider evidence base, and to make IV iron infusions routinely available as part of surgical care and all patients with iron deficient anaemia .
The findings strengthen and extend the case for surgical patients that was developed by the UCL-led PREVENTT trial in major abdominal surgery. It should now be routine that all patients are screened early enough for anaemia and iron deficiency to facilitate diagnoses and treatment as an integral part of the perioperative pathway. ITACS now provides direct evidence in cardiac surgery that preoperative IV iron can reduce transfusion exposure and improve patient postoperative recovery.
Spokesperson quotes
| Spokesperson | Draft quote |
| Professor Toby Richards, Senior Author, Director of The Iron Clinic, Global iron deficiency expert | “ITACS should be a turning point in how we manage anaemia in patients for surgery. This landmark trial shows that a single IV iron infusion before heart surgery can reduce the need for donated blood and help patients recover better. At a time when the NHS is under intense pressure and blood supplies remain vulnerable, failing to diagnose and treat anaemia in preparation (and recovery) for surgery is no longer tenable. NICE should now review its guidance so that anaemia screening and effective treatment, including IV iron as a routine NHS practice.NICE currently says, ‘refer to specialist services’ this needs to be changed to IV iron as a routine service.” |
| Professor Sue Pavord, former President of the British Society for Haematology | “This international trial showed that a simple infusion of intravenous iron before cardiac surgery reduced the need for blood transfusion. As well as the obvious benefit to individual patients, this saves around 44 units of blood products for every 100 patients treated -crucial during this period of national blood shortages.” |
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