Postoperative i.v. Iron Substitution in Patients With Diagnosed Iron Deficiency

Inclusion Criteria:

• Males or female; aged ≥ 18 years
• Patients after major surgery (e.g., orthopaedic/trauma, vascular, visceral, cardiacsurgery) with risk of Hb reduction and/or blood loss who develop anaemia defined ashaemoglobin of <12 g/dL for female and <13 g/dL for men within 12 to 72 h after startof surgery and with confirmation at Baseline
• Confirmed and documented preoperative iron deficiency defined as S-ferritin <100 ng/mLwithout anaemia (Hb ≥12 g/dL for female and ≥13 g/dL for male) within 28 days beforesurgery
• need for fast iron replenishment as judged by the treating physician
• Written informed consent; willing/able to comply with the protocol

Exclusion Criteria:

• Pregnancy in female patients or breastfeeding women
• Female patients not willing to use a safe method of contraception (PEARL index <1) forthe full study period
• Severe physical inability, e.g., American society of anesthesiologists (ASA) physicalstatus IV or V
• Patients receiving blood transfusion 24 week prior surgery
• Non-iron deficiency anaemia, e.g., known Vitamin B12 or folate deficiency,haemoglobinopathy, or unexplained anaemia
• Anticipated medical need for erythropoiesis-stimulating agents during the main studyperiod
• Patients with hemodynamic instability due to any ongoing bleeding. Absence of ongoingbleeding will be confirmed determined either by decision of two independent physiciansor by removal of drainage, whichever occurs earlier in routine care)
• Patients with any contraindication to the investigational products, e.g.,

1. known sensitivity to iron or an ingredient of the investigational products
2. Significant history of systemic allergic reactions
3. Haemachromatosis, thalassemia or TSAT >50% as indicator of iron overload
4. Acute or chronic intoxication
5. Infection (patient on non-prophylactic antibiotics)
6. Chronic liver disease and/or screening Alanine Aminotransferase (ALT) orAspartate Aminotransferase (AST) above three times the upper limit of the normalrange

• Chronic kidney disease, defined as Glomerular Filtration Rate (GFR) <30 mL/min
• Active uncontrolled immune-mediated diseases such as rheumatoid arthritis orinflammatory bowel disease
• Primary haematologic disease
• Drug or alcohol abuse according to WHO definition
• Potentially unreliable patients, and those judged by the investigator to be unsuitablefor the study
• Current or previous participation in another clinical trial during the last 90 daysbefore screening
• Exclusion criteria related to Ferrous sulfate

1. according to Summary of product characteristics (SmPC)
2. hypersensitivity to any ingredient in the formulation
3. concomitant parenteral iron
4. haemochromatosis, and other iron overload syndromes

• Exclusion criteria related to Ferric Carboxymaltose:

1. according to Summary of product characteristics (SmPC)
2. hypersensitivity to the active substance, to Ferric Carboxymaltose or any of itsexcipients
3. known serious hypersensitivity to other parenteral iron products
4. anaemia not attributed to iron deficiency
5. evidence of iron overload or disturbances in the utilisation of iron

• Exclusion criteria related to Polyglucoferron

1. hypersensitivity to any ingredient in the formulation
2. known serious hypersensitivity to other parenteral iron products
3. anaemia not attributed to iron deficiency
4. evidence of iron overload or disturbances in the utilisation of iron