Top Things to Know: Perioperative Anemia and Patient Blood Management in Cardiac Surgery
Updated: June 22, 2026
Prepared by Linda Shore-Lesserson, MD; Writing Group Vice Chair
- Preoperative anemia is present in up to 50% of adult patients presenting for cardiac surgery and is associated with increased morbidity and mortality after surgery.
- Iron deficiency is present in 20–50% of patients presenting for cardiac surgery and may occur with or without anemia; it is a modifiable risk factor for morbidity and should be identified during preoperative screening.
- Iron deficiency screening in patients with heart failure, regardless of anemia status, is recommended by the European Society of Cardiology (ESC) and treatment is recommended by both the ESC and the American Heart Association to improve symptoms and reduce hospital readmissions.
- Preoperative anemia management reduces the risk of needing a red blood cell transfusion and thus can reduce the risk of transfusion-associated complications such as alloimmunization in patients undergoing cardiac surgery.
- Anemia management is a critical component of Enhanced Recovery After Cardiac Surgery (ERAS) protocols and requires a strong multidisciplinary commitment to ERAS.
- Red blood cell transfusion in adult cardiac surgery is associated with increased risk for acute kidney injury, stroke, and mortality. Thus, restrictive transfusion thresholds have been recommended in surgical society clinical practice guidelines.
- A structured multidisciplinary approach to intraoperative blood conservation includes minimizing hemodilution, technologic advances in the cardiopulmonary bypass circuit, utilizing autologous techniques, and antifibrinolytic drug therapy.
- Coagulation perturbations during cardiac surgery can be measured at the point of care and treated with therapy aimed at the specific hemostasis abnormality, thus reducing allogeneic transfusion and providing patient-centered care.
- Patients for whom blood products are not an option can be successfully cared for during cardiac surgical procedures using the tenets of Patient Blood Management and knowledge of the patients’ personal preferences.
- Considerations for anemia and patient blood management may differ in specific patient populations such as pediatric patients, adults and children with congenital heart disease, female patients, and other patients in underrepresented cohorts.
Citation
Howard-Quijano K, Shore-Lesserson L, Osho A, Raphael J, Rove JY, Panigrahi AK, Morton-Bailey V, Kamlesh Vegrecha A, Baker RA; on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia; and the Council on Clinical Cardiology. Perioperative anemia and patient blood management in cardiac surgery: a scientific statement from the American Heart Association. Circulation. Published online June 22, 2026. doi: 10.1161/CIR.0000000000001446