May 2025, Volume 3, Issue 5

Author

Joel Vasanth Peter, Deepak Narayanan A, J.V. Peter and Sathish Kumar Dharmalingam

Abstract

Objective: To study if preoperative iron and vitamin B12 supplementation in anaemic patients undergoing coronary artery bypass graft (CABG) surgery would reduce transfusion requirements perioperatively. Materials and methods: In this prospective non-randomised study, consenting patients received 20 mg/kg of ferric carboxymaltose intravenously and 1-mg of vitamin B12 subcutaneously (treatment arm). The control arm did not receive supplements. The primary outcome was perioperative transfusion requirement. Secondary outcomes included duration of ventilation and intensive care stay. The difference in transfusion requirements, haemoglobin and length of stay were assessed using Chi-square and Fisher's exact test as appropriate. Factors associated with ?2 red cell (RBC) transfusions were explored using bivariate and multivariate logistic regression analysis and expressed as odds ratio (OR) with 95% confidence intervals (CI). Results: The mean (SD) age of the cohort was 61 (8) years; 79% were males. Baseline heart rate, body mass index, blood pressure, co-morbidities and creatinine were similar in the treatment (n=45) and control (n=159) arms. The median (IQR) EuroSCORE-II was 0.94 (0.7-1.2) in cases and 0.93 (0.7-1.3) in controls. The median preoperative hemoglobin was 11.6 (11.1-12.5) g/dl and not different (p=0.63) in cases and controls. RBC transfusion requirement was similar (p=0.69) perioperatively in cases (1.38 (1.11) units) and controls (1.46 (1.17)). Fresh frozen plasma (p=0.98) and platelet (p=0.13) transfusions were similar in both groups; 4 patients needed cryoprecipitate. On multivariable logistic regression analysis, female gender (OR 2.76, 95%CI 2.16-14.7), higher EuroSCORE-II (3.77, 1.53-9.31) and longer cross-clamp time (1.04, 1.01-1.06) were independently associated with the need for ?2 RBC transfusions perioperatively. Conclusions: The acute preoperative administration of ultra-short acting iron and vitamin B12 in patients undergoing CABG surgery did not reduce perioperative transfusion requirements. Several factors were associated with the need for ?2 RBC transfusions.