Rethinking Iron Deficiency Anaemia Management: between PBM and Modern Clinical Practice

At IMCID 2025, Prof. Manuel Muñoz outlines how the evolving concept of Patient Blood Management is shaping new clinical protocols and shifting attention to safer, cost-effective iron supplementation.

The 9th International Multidisciplinary Course on Iron Deficiency (IMCID) marked a pivotal moment in the global dialogue on iron deficiency and anaemia management. One of the central figures of this year’s edition was Prof. Manuel Muñoz, from the University of Málaga and a leading member of NATA and IFPBM, as well as chair of the IMCID Scientific Committee. With decades of experience in perioperative care and anaemia management, Prof. Muñoz offers a comprehensive overview of the key takeaways from this year’s scientific program, with a special focus on Patient Blood Management (PBM) and its future direction.

Professor Muñoz, what has made this edition of IMCID particularly significant in terms of clinical relevance and scientific contribution?

This ninth edition featured 32 lectures delivered by an international faculty, providing a robust update on the prevalence, causes, and consequences of iron deficiency across a wide range of clinical conditions. A major highlight was the discussion on diagnostic strategies: as emphasized by Swinkels and Cabantchik, no single test reliably quantifies iron availability in all scenarios. Instead, clinicians must consider the full clinical picture alongside laboratory results to make informed decisions.

The course also delivered key updates across clinical fields:

• In Cardiology, studies showed how myocardial iron modulation by empagliflozin might explain its benefit in heart failure (HF), while oral Sucrosomial® Iron (SI) proved as effective as IV ferric carboxymaltose (FCM), even outperforming FeSO₄ in cardiac function restoration (Vinci). Sucrosomial® Iron has now been included in the WHO 2025 PBM implementation guidelines as a potential cost-saving oral alternative for non-anaemic iron deficiency in HF patients.
• In Gastroenterology, oral SI improved haemoglobin and iron stores in ulcerative colitis (Bertani) and demonstrated positive effects on gut microbiota and inflammation (Frazer).
• In Oncology, lboth preventive and proactive iron supplementation were shown to be more cost-effective than reactive IV treatments. New hypotheses also explored ferroptosis-targeting agents and iron-bound antibiotics as novel strategies for cancer and resistant infections.
• In Internal Medicine and Haematology, SI demonstrated efficacy equal or superior to traditional oral formulations with fewer GI side effects. A sublingual route also showed promise for patients with neurological swallowing disorders.
• In Gynaecology and Obstetrics, high-dose SI was well tolerated postpartum and effective in surgical settings like uterine fibroid ablation.
• In Paediatrics, Sucrosomial® Iron was shown to support preterm infants and children with celiac disease or anaemia, even at lower doses than iron polymaltose.

What are the latest PBM protocols for surgical patients, and how is iron integrated into them?

PBM is evolving into a broader concept of “blood health”, as it becomes integrated into daily patient care. Yet, perioperative anaemia remains a challenge. At IMCID, we presented a Spanish consensus clinical pathway designed to clarify who, when, how, and with what to treat perioperative anaemia. This structured approach aims to overcome existing barriers.

Additionally, two new guidelines were highlighted:

• The 2024 AECTS/AECTAIC PBM Guidelines for adult cardiac surgery
• The 2023 UK Centre for Perioperative Care Anemia Guideline

These guidelines emphasize timely diagnosis and treatment, including iron supplementation

Did IMCID highlight any major shifts in preoperative anaemia treatment that could influence clinical practice?

Absolutely. All three guidelines recommend iron supplementation for preoperative IDA. The Spanish clinical pathway, based on data from multiple surgical fields (cardiac, vascular, orthopaedic, bariatric, gynaecological), recommends Sucrosomial® Iron as an effective and cost-efficient alternative to IV iron—especially when IV administration is contraindicated or logistically difficult.

In cardiac surgery, IMCID data confirmed the effectiveness of SI in pre- and postoperative IDA management (Weltert, Venturini), leading to its Class IIa recommendation in the 2024 AECTS/AECTAIC guidelines.Notably, the 2023 UK CPOC anaemia guideline published in the British Journal of Anaesthesia referred to Sucrosomial®Iron as “an exciting development that could change the landscape of anaemia treatment,” praising its tolerance at high doses, independence from ferroprotein pathways, and resistance to hepcidin regulation”.

From diagnostics to treatment protocols, IMCID 2025 reinforced the value of integrating iron supplementation — particularly oral alternatives — within modern Patient Blood Management strategies. Prof. Muñoz’s contribution highlights a clear direction: embracing evidence-based, cost-effective, and patient-friendly solutions to reduce the global burden of anaemia across clinical settings.

The Abstract Book of the 9^th IMCID – International Multidisciplinary Course on Iron Deficiency, held in Palermo (Sicily, Italy) from 3 to 4 April 2025, has been published as Supplement n°3 of the last issue of May 2025 of the international journal Blood Transfusion (IF=2.4).
Download the abstract book here!