Thorac Cardiovasc Surg
DOI: 10.1055/a-2176-2218
Original Cardiovascular

Implementation of a Short-term Treatment Protocol in Anemic Patients before Cardiac Surgery

1   Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel
Dana Abraham*
2   Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
Maayan Shiner
3   Blood Bank Haifa, Carmel Medical Center, Haifa, Israel
Naama Schwartz
4   Research Authority, Carmel Medical Center, Haifa, Israel
Ophir Lavon
5   Clinical Pharmacology, Carmel Medical Center, Haifa, Israel
Erez Sharoni
1   Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel
› Author Affiliations


Background We assessed whether implementation of an immediate preoperative treatment in anemic patients could result in fewer perioperative packed red blood cell (PRBC) transfusions and improved outcomes in a real-world setting.

Methods From January 1, 2020, to November 31, 2022, we implemented a perioperative protocol for anemic patients (hemoglobin (Hb) level in women <11.5 g/dL, men <12.5 g/dL), which included subcutaneous erythropoietin α, intravenous Iron, and intramuscular vitamin B12 (all given preoperatively) and per os iron and folic acid given once a day postoperatively. We retrospectively compared all patients receiving the protocol to all eligible patients who were operated upon in the 4 years prior to implementation of the protocol. Primary outcome was amount of PRBC transfusions during surgery and index admission.

Results In the months after protocol implementation, 114 patients who received the treatment protocol were compared with 236 anemic patients in the 4 years prior to who did not receive the protocol. The treatment reduced total PRBC use (control group median 4 [2–7] units vs. treatment 2 [1–3] units, p < 0.0001) and the incidence of postoperative blood products transfusions (treatment group 58 patients, 50.88% vs. control group 177 patients, 75%, p < 0.0001). Hb prior to discharge was higher among the protocol group (treatment median 9 g/dL [8.3–9.5 g/dL] vs. control 8.6 g/dL [8.1–9.1 g/dL], p = 0.0081).

Conclusion Despite some differences compared with previously described protocols, the implementation of a perioperative treatment protocol for anemic patients was associated with a reduction in PRBC transfusion in a real-world setting.

Authors' Contribution

Both D.B.L. and D.A. contributed equally to the conceptualization, data collection, interpretation of the results, writing and editing the manuscript. Both authors invested the same number of hours and effort in this paper.

* These authors contributed equally.

Supplementary Material

Publication History

Received: 04 June 2023

Accepted: 12 September 2023

Accepted Manuscript online:
14 September 2023

Article published online:
30 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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