Impact of Iron Deficiency on Patients Undergoing Cardiac Surgery

Iron deficiency (ID), with or without anemia, is a frequent and underrecognized condition among patients undergoing cardiac surgery, and it is associated with worse perioperative outcomes, including higher mortality, longer ICU and hospital stays, and increased transfusion requirements. This review summarizes current evidence on the prognostic role of ID and the effectiveness of supplementation strategies. While intravenous iron therapy has shown potential to improve hemoglobin levels and reduce transfusion needs, study results remain inconsistent, partly due to differences in timing, dosage, and formulations used. Newer oral agents and nanotechnology-based delivery systems offer improved bioavailability and tolerability, though clinical data in cardiac surgery remain limited. Overall, routine preoperative screening for ID using ferritin and Transferrin Saturation is essential, particularly in non-anemic patients, as timely supplementation may improve perioperative recovery. Intravenous administration remains the preferred method in moderate to severe cases. However, standardized protocols and further high-quality randomized trials are required to define the optimal management of iron deficiency in this high-risk population.