Documento de posición sobre el impacto clínico de la anemia y la deficiencia de hierro previo a cirugía cardiaca. Parte 1: diagnóstico

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.