Position paper on the clinical impact of anemia and iron deficiency prior to cardiac surgery. Part 1: diagnosis

Manuel Chacón-Diaz, Departamento de Cardiología, Unidad Coronaria, Servicio de Cardiología, Clínica Delgado-AUNA, Lima, Perú
Alexandra Arias-Mendoza, División de Cardiología, Asociación Nacional de Cardiólogos del Centro Médico La Raza, AC (ANCCMR)
Sebastián García-Zamora, Departamento de Cardiología, Unidad Coronaria, Servicio de Cardiología, Sanatorio Delta, Rosario, Argentina
Ricardo López-Santi, Departamento de Cardiología, Hospital Italiano de La Plata, La Plata, Argentina
Adrian Baranchuk, Facultad de Medicina, Universidad Abierta Interamericana (UAI), Buenos Aires, Argentina
Vladimir E. Ullauri-Solórzano, Departamento de Cardiología, Hospital Metropolitano, Quito, Ecuador
María I. Sosa-Liprandi, Departamento de Cardiología, Sanatorio Güemes, Buenos Aires, Argentina
Miguel A. Quintana, Consejo de Emergencias y Cuidados Críticos Cardiovasculares, Sociedad Interamericana de Cardiología, Ciudad de México, México
Joaquín Perea, Consejo de Emergencias y Cuidados Críticos Cardiovasculares, Sociedad Interamericana de Cardiología, Ciudad de México, México
Ricardo Villarreal, Consejo de Emergencias y Cuidados Críticos Cardiovasculares, Sociedad Interamericana de Cardiología, Ciudad de México, México
Gabriel Aisenberg, Departamento de Medicina Interna General, Servicio de Medicina Interna, Universidad de Texas, Houston, EE.UU.
Johanna Contreras, Departamento de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Mount Sinai School of Medicine, Mount Sinai Fuster Heart Hospital, Nueva York, EE.UU.
Paola A. Morejón-Barragán, Clínica Guayaquil, Guayaquil, Ecuador
Mohammad El-Diasty, Departamento de Cirugía Cardíaca, Servicio de Cirugía, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Centre, Cleveland, EE.UU.
Melisa Elfman, Departamento de Cardiología, Unidad Coronaria, Servicio de Cardiología, Sanatorio Güemes, Ciudad Autónoma de Buenos Aires, Argentina
Marina Pérez-Bec, Departamento de Cardiología, Unidad Coronaria, Servicio de Cardiología, Sanatorio Güemes, Ciudad Autónoma de Buenos Aires, Argentina
Juan E. Gómez-Mesa, Departamento de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Fundación Valle del Lili y Universidad ICESI, Cali, Colombia
Marcelo Nahin, Departamento de Cirugía Cardiaca, Servicio de Cirugía, Hospital de Alta Complejidad en Red El Cruce, Florencio Varela, Buenos Aires, Argentina
Ana G. Múnera, Departamento de Ecocardiografía, Servicio de Cardiología, Hospital General de Medellín, Medellín, Colombia
M. Cecilia Braxs, Departamento de Hematología, Servicio de Hematología, Clínica Universitaria Reina Fabiola, Córdoba, Argentina

Anemia and iron deficiency (ID) are highly prevalent among patients undergoing cardiac surgery and are consistently associated with worse clinical outcomes. Despite their clinical relevance, these conditions remain underdiagnosed in routine practice. With this document, we aim to summarize the pathophysiological basis, diagnostic criteria, and clinical impact of anemia and ID in the perioperative setting of cardiac surgery. This position statement was developed by the Inter-American Society of Cardiology through a multidisciplinary panel of experts from multiple countries across the continent. Recommendations were formulated based on the best available evidence and adapted to the Latin American context. The recommended threshold for defining preoperative anemia in both sexes is a hemoglobin level < 13 g/dL. Iron deficiency may occur with or without anemia; absolute ID is defined as ferritin < 100 μg/L, whereas functional ID is characterized by normal or elevated ferritin levels with a transferrin saturation < 20%. Functional ID is particularly common in cardiovascular disease due to chronic low-grade inflammation. The combined interpretation of hemoglobin, ferritin, and transferrin saturation is essential; in selected cases, additional laboratory testing or specialist evaluation may be required. Both anemia and ID independently correlate with higher perioperative morbidity and mortality, increased transfusion requirements, prolonged hospitalization, and greater healthcare resource utilization, with risk proportional to the severity of these conditions. In conclusion, systematic preoperative screening for anemia and ID is critical to prevent avoidable complications and to optimize clinical outcomes in patients undergoing cardiac surgery.

Keywords: Perioperative anemia. Iron deficiency. Cardiac surgery. Patient blood management. Iron.