Post-operative Intravenous Iron to Treat Iron-deficiency Anemia in Patients Undergoing Cardiac Surgery

Inclusion Criteria:

Patients who are undergoing any non-emergency cardiac surgery with cardiopulmonary bypass (CPB) and who meet all following criteria:

1. Age greater than 18 years old

2. Preoperative iron-deficiency with or without anemia (defined as Hb <130 g/L) withany one of:

3. ferritin ≤ 300 μg/L and transferrin saturation ≤ 20%; or

4. reticulocyte Hb content < 29 pg, where available

Exclusion Criteria:

Patients who meet any of the following criteria are not eligible for the study:

1. specialized procedures (e.g., ventricular assist device insertion, thoracoabdominalaneurysm, complex adult congenital surgery and heart transplant)

2. established contraindications to IV iron:

3. hypersensitivity to the iron product

4. history of >2 food and/or drug allergic reactions (excluding drug intolerance)

5. non-iron deficiency anemias such as myelodysplastic syndrome

6. history of iron overload or disturbances in use of iron such as hemochromatosisor hemosiderosis

7. decompensated liver cirrhosis (MELD ≥ 19) or active hepatitis

8. active infection

9. preoperative unstable hemodynamics defined as the requirement for vasopressors orinotropes, or active bleeding (as noted in the clinical record and/or defined as arequirement for red blood cell transfusion for ongoing clinical bleeding)

10. refusal of blood products for religious or other reasons

11. known pregnancy

12. already enrolled in this trial

13. enrolment in another interventional trial which may impact anemia or transfusionmanagement (for example, a trial of hemostatic therapies, such as tranexamic acid)

14. receipt of intravenous iron at any point in the 6 weeks prior to randomization