Key result
Preoperative oral iron linked to ~1.0 g/dL Hb increase in anemic children awaiting noncardiac surgery.
Why the study?
Preoperative anaemia in children is linked to increased morbidity, mortality, and blood transfusions, but the haemoglobin response to oral iron in children with iron-deficiency anaemia undergoing elective noncardiac surgery was unmeasured.
Does oral iron improve haemoglobin levels in children with iron-deficiency anaemia undergoing elective noncardiac surgery?
Does oral iron improve haemoglobin levels in children with iron-deficiency anaemia undergoing elective noncardiac surgery?
A pragmatic preoperative anaemia-management pathway using oral iron is feasible and produces a modest increase in haemoglobin in children with iron-deficiency anaemia awaiting noncardiac surgery.
May support preoperative oral iron in iron-deficient children; hypothesis-generating for transfusion or outcome benefits pending RCTs.
Background Preoperative anaemia in children is associated with increased morbidity, mortality, and blood transfusion exposure. This study aimed to evaluate a pragmatic preoperative anaemia pathway and the haemoglobin (Hb) response (ΔHb) to oral iron in children with iron-deficiency anaemia (IDA) undergoing elective noncardiac surgery in South Africa. Methods This prospective pragmatic study with a pre–post design was conducted at two academic hospitals in South Africa from February 2023 to March 2025. Children aged >6 months to <16 yr were first screened using point-of-care capillary HemoCue®. Children with laboratory-confirmed IDA received oral iron and selective deworming. The primary outcome was ΔHb. Secondary outcomes included anaemia prevalence detected by point-of-care screening with HemoCue®, proportion of IDA among children with laboratory-confirmed anaemia, improvement or resolution of anaemia, and feasibility measures. Results On preoperative HemoCue® screening, 177/755 (23.4%; 95% confidence interval 20.4–26.6%) children had Hb concentrations below WHO age-specific thresholds. Among the 175 children who underwent confirmatory laboratory testing, 71/175 (40.6%) had anaemia. Of these, 39/71 (54.9%) had IDA, with 35/39 (89.7%) completing follow-up. Median ΔHb was 1.0 g dl −1 (interquartile range 0.5–1.8; P =0.001). The WHO anaemia severity category (defined as mild, moderate or severe) improved in 23/35 (65.7%) children, and 17/35 (48.6%) were no longer anaemic. Adherence was high and side effects infrequent. Conclusions This pragmatic preoperative anaemia-management pathway was feasible and produced a modest increase in Hb in children with IDA. These findings highlight the potential role of structured optimisation pathways and support further evaluation in resource-limited settings. Clinical trial registration ClinicalTrials.gov (NCT05681871).
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Meyer et al. (2026) studied Iron-deficiency anaemia in children undergoing elective noncardiac surgery (n=755). Oral iron and selective deworming vs. Pre-intervention baseline was evaluated on Haemoglobin (Hb) response (ΔHb) (Median ΔHb 1.0 g dl-1, p=0.001). Preoperative oral iron administration produced a median haemoglobin increase of 1.0 g/dL (IQR 0.5–1.8; P=0.001) in children with iron-deficiency anaemia awaiting noncardiac surgery.
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