An intravenous iron drip given before cardiac surgery reduced how often anemic patients needed a blood transfusion, according to a randomized trial published August 19, 2026 in The BMJ. Across 955 adults, the treatment saved about 44 units of blood products for every 100 patients treated.
The ITACS trial enrolled patients with anemia scheduled for elective cardiac surgery at 33 hospitals across 10 countries between July 2016 and December 2023. Participants had an average age of 66, and 60 percent were men.
Red blood cell transfusions were needed in 61 percent of the iron group, compared with 68 percent in the placebo group. Patients who received iron also spent one extra day alive and at home in the 90 days after their operation, an average of 81 days versus 80.
Why anemia matters before heart surgery
Anemia means the blood carries fewer of the red cells that ferry oxygen to organs and tissues. About one-third of patients scheduled for cardiac surgery are anemic when they arrive, and between 20 and 50 percent end up receiving a transfusion around the operation.
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Those transfusions are not risk-free. Transfused red cells are linked to a higher chance of complications, longer hospital stays and higher mortality after cardiac procedures. Even routine transfusions can trigger allergic or febrile reactions, with rarer events including transfusion-related acute lung injury and circulatory overload.
Why iron by drip, not by pill
Oral iron works, but it takes weeks to rebuild stores. Guidance for cardiac surgery patients notes that oral iron typically requires daily intake for at least four weeks to raise hemoglobin, and many people on a surgery waiting list do not have that much runway. Intravenous iron delivers a larger dose in one visit and can work when given only a few days before the operation.
The ITACS team, led by Professor Paul Myles at Monash University and Alfred Health in Melbourne, tested a single preoperative iron infusion against a placebo in a double-blind design. The Australian National Health and Medical Research Council funded the work.
What patients can ask their surgeon
The findings do not put every heart patient on an iron drip. Anemia should be picked up early, and the right response depends on why the counts are low. Patients scheduled for a cardiac procedure can ask whether they have been screened for anemia and iron deficiency, how much time there is before surgery, and whether iron replacement fits into their pre-surgery plan.
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The trial did not show fewer major complications or shorter hospital stays with iron, and the extra day at home was a modest signal. Still, the researchers acknowledged the enrolled cohort had anemia without a required test for absolute iron deficiency, which may have blunted the effect. A measurable drop in transfusion need still matters in a system that constantly balances blood supply against demand.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.