Preoperative anaemia is common in surgery, with a prevalence between 10 and 50 %, and is an independent risk factor for morbidity and mortality. Due to the potential risk of additional blood loss, anaemia represents a serious disease condition within the surgical field. Especially patients undergoing major elective surgery are at risk of substantial blood loss. Anaemia is mostly the result of an inadequate erythropoiesis due to iron deficiency, lack of vitamin B12 or folate, and bone marrow diseases. Among the elderly, renal disease and chronic inflammation account for approximately one-third of all anaemia incidences. The aim of this study is to provide detailed data about the prevalence of preoperative deficiencies in iron, vitamin B12 and/or folate and the presence of underlying renal or chronic diseases in patients undergoing major surgery. Results will facilitate design of supplementation strategies to improve haemoglobin level before surgery.


The main objective of ALICE is to estimate the prevalence of preoperative anaemia and subtypes (anaemia caused by deficiency in iron, vitamin B12 and/or folate, and renal or chronic disease) in patients undergoing major surgery. A secondary objective is the assessment of the association of preoperative anaemia and subtypes with in-hospital morbidity and mortality accounting for other predictive factors (e.g. age, surgical discipline).

Study design

ALICE is a worldwide multicentre, prospective observational study.
Recruitment period: 1 week

Inclusion criteria

• Age ≥ 18 years
• Written informed consent prior to study participating according to the national law requirements
• Patients undergoing major surgery
• Expected hospital stay with a minimum of 24 hours

Exclusion criteria

• Preoperative autologous blood donation
• Patients with expected re-surgery within the planned 7-day recruitment period

Recording of endpoints

All data will be collected and there will be no study-related interventions.



Here is our 14th newsletter -> ALICE-Newsletter_#14
Here is our 13th newsletter -> ALICE-Newsletter_#13

Last patient in: Decembre 2021!!!

End of study period: March 2022!!!

Here is our 12th newsletter -> ALICE-Newsletter_#12
Here is our 11th newsletter -> ALICE-Newsletter_#11
Here is our 10th newsletter -> ALICE-Newsletter_#10
Here is our 9th newsletter   -> ALICE-Newsletter_#9
Here is our 8h newsletter    -> ALICE-Newsletter_#8

Since July 2021, 3 hospitals recruited patients and another 4 hospitals are starting patient recruitment this week:
Dr Wiesenack from Ev. Diakoniekrankenhaus Germany
Dr Hamid from East Nile Hospital Sudan
Dr Daper from CHU Charleroi Belgium
Dr Wittmann from University Hospital Bonn Germany
Dr Reichmayr from Klinik Floridsdorf Austria
Dr Gomez Lopez from Hospital de Medina del Campo Spain
Dr Gibbs from University of Cape Town and Groote Schuur Hospital South Africa
Thank you very much for your commitmemt and support

Since June 2021, 6 hospitals recruited patients and we are looking forward to receive an update about the numbers of recruited patients
Dr Bouzo from Hospital 12 de Octubre Spain
Dr Del Moral from Hospital Santa Creu i Sant Pau Spain
Dr Balanika from Onassis Cardiac Surgery Center Greece
Dr Gaudriot from CHU de Rennes France
Dr Matias from Centro Hospitalar de Setúbal Portugal
Dr Schmartz from CHU Brugmann Belgium

We are very excited , that Dr Hytham Hamid from the East Nile Hospital (Sudan) and Dr Matthew Hart from the SATURN Network in Nee Zealand , Dr Wiesenack & Dr Wittmann from Germany and Dr Reichmayr/Dr Spiel from Austria will recruit patients within the upcoming weeks . THANK YOU!

Here is our 6th newsletter -> ALICE-Newsletter_#6

It is incredible! Since March 2021, 8 hospitals recruited patients:
Dr Pérez de Arriba from the Hospital Universitario Central de Asturias Spain
Dr Basaro from the Hospital Clinic Barcelona Spain
Dr Filipescu from the Emergency Institute of Cardiovascular Disease Romania
Dr Órfão from the University Hospital Center and Biomedical Coimbra Portugal
Dr Bisbe from the Hospital del MAR Spain
Dr Stefanov from Cleveland Clinic Abu Dhabi United Emirates
Dr Lasocki from CHU Angers France
Dr Moreau from the Centre Hospitalier DAX France


Here is our 5th newsletter -> ALICE-Newsletter_#5
Here is our 4th newsletter -> ALICE-Newsletter_#4

In this newsletter we show the results of our survey. We thank all centres for their participation. You can find the results of the survey also in PubMed! Please check out: Judd et al, The impact of the SARS-CoV-2 pandemic on the ongoing prospective, international, multicentre observational study assessing the preoperative anaemia prevalence in surgical patients (ALICE-trial) Transfus Med . 2021 Oct;31(5):387-390. doi: 10.1111/tme.12792.

Here is our 3rd newsletter -> ALICE-Newsletter_#3

Special thank to Dr Sandra Gionne from the Rizzoli Orthopedic Institute in Bologna (Italy) for her incredible support! The National Society of Anesthesia (SIAARTI) is actively promoting the study on newsletters and websites.


Due to the Corona-crisis we are extending the study period. Last patient in: 29.08.2021

Please find our 2nd newsletter -> ALICE-Newsletter_#2

We are proud to present our first newsletter!!! Thanks to everyone  -> ALICE-Newsletter_#1

The Tzaneio General Hospital of Piraeus under supervision of Dr Evangelia Samara and her Team recruited 27 patients! We are very proud that Dr Evangelia Samara joined the Trial and we are overwhelmed by her commitment. First contact: 13.11.2019, first patient in: 06.01.2020

ALICE is registered at clinical Trial!!!!     NCT03978260     ->

The University Hospital Frankfurt under supervision of Prof. Dr. Meybohm, Prof. Dr. Dr. Zacharowski, Leonie Judd and Dr. Suma Choorapoikayil performed the study and included 67 patients.

Participating Centres

(in alphabetic order by city)

  • Abu Dhabi: Cleveland Clinic Abu Dhabi (AE)
  • Angers: University of Angers (FR)
  • Ankara: Ankara University Faculty of Medicince & Ufuk University Faculty of Medicine, Department of Anesthesiology and Reanimation & Diskapi Yildirim Beyazit Education and Research Hospital & Gazi University Hospital (TR)
  • Athens: Aretaieion University Hospital & General Hospital „Alexandra“ (GR)
  • Auckland: Auckland City Hospital & Middlemore Hospital & North Shore Hospital & National Women’s Hospital (NZ)
  • Augsburg: Klinikum Augsburg (DE)
  • Aveiro: Centro Hospitalar do Baixo Vouga (PT)
  • Barcelona: University Hospital Mar-Esperança & Hopsital Santa Creu i Sant Pau & Universitaria de Manresa & Hospital Clinic de Barcelona & Hospital de Bellvitge & Althaia Xarxa Assistencial Universitària de Manresa (ES)
  • Brest: Hopital d’Instruction des Armées Clermont Tonnerre de Brest (FR)
  • Bocholt: Klinikum Westmünsterland (DE)
  • Bologna: Anesthesia and Intensive Care Rizzoli Orthopedic Institute (IT)
  • Bonn: University Hospital Bonn & Gemeinschaftskrankenhaus Bonn & Johanniter Klinik (DE)
  • Bruxelles: Hôpital Universitaire des Enfants Reine Fabiola & Hopital ERASME  & Universitaires Saint Luc (BE)
  • Bucharest: Emergency Insititut of Cardiovascular Disease (RS) & Anesthesiology and Intensive Care Department of the Emergency Clinical Hospital
  • Cape Town: Department of Anaesthesia and Perioperative Medicine University of Cape Town and Groote Schuur Hospital (SA)
  • Chaleroi: CHU Chaleroi
  • Christchurch: Christchurch Hospital (NZ)
  • Clui-Napaco: County Hospital Cluj (RO)
  • Coimbra: University Hopsital of Coibra (PT)
  • Dax: CH Dax (FR)
  • Dunedin: Dunedin Hospital (NZ)
  • Foch: Hopital Foch (FR)
  • Frankfurt: University Hospital Frankfurt (DE)
  • Freiburg: Ev. Diakoniekrankenhaus (DE)
  • Gran Canaria: Hospital Universitario de Gran Canaria (ES)
  • Graz: Medical University Graz (AT)
  • Hamilton: Waikato Hospital (NZ)
  • Horgen: See-Spital Horgen (CH)
  • Istanbul: Istanbul University (TR)
  • Jacksonville: University of Florida College of Medicine- Jacksonville (US)
  • Karthum: East Nile Hospital (SU)
  • Ljubljana: University Medical Centre Ljubljana (SI)
  • Lyon: Clinique de la Sauvegarde & 28 Prom. Léa et Napoléon Bullukian (FR)
  • Madrid: Infanta Leonor University Hospital & Hospital XII de Octubre & Hospital la Paz (ES)
  • Milan: Istituto Clinico Galeazzi sede San Siro in Milan (IT)
  • Nantes: Centre Hospitalier universitaire de Nantes (FR)
  • Oviedo: Hospital Universitario Central de Asturias (ES)
  • Patras: University Hospital of Patras (GR)
  • Piraeus: Tzaneio General Hospital of Pireus (GR)
  • Poitiers: CHU de Poiters (FR)
  • Prishtina: Faculty of Medicine University of Prishtina, American Hospital Kosovo
  • Rennes: CHU de Rennes (FR)
  • Rome: National Cancer Insitute (IT)
  • Sabadell: Hospital Parc Tauli de Sabadell (ES)
  • Saint-Etienne: CHU Saint Etienne (FR)
  • Saint Pierre: CHU de la Reunion (FR)
  • Sakarya: Sakarya University School of Medicine (TR)
  • Seoul: Asan Medical Center-University of Ulsan, Konkuk University Medical Center (KR)
  • Setbual: Centro Hospitalar de Setúbal
  • Straubing: Klinikum St. Elisabeth Straubing GmbH (DE)
  • Toulouse: CHU TOULLOUSE (FR)
  • Tournai: Centre Hospitalier de Wallonie Picarde (BE)
  • Valence: Universitari Dr Peset (ES)
  • Valladolid: Clinic University Hospital of Valladolid & Hospital de Medina del Campo (ES)
  • Vienna: Medical University Vienna & Krankenhaus Nord-Klinik Floridsdorf (AT)
  • Winterthur: Kantonspital Winterthur (CH)
  • Zagreb: UCH Zagreb (HR)
  • Zurich: University Hospital Zurich (CH)


Principle Investigator:

Dr. Suma Choorapoikayil

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy
University Hospital Frankfurt
Theodor-Stern-Kai 7
60590 Frankfurt am Main, Germany

Prof. Dr. Dr. Zacharowski

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy
University Hospital Frankfurt
Theodor-Stern-Kai 7
60590 Frankfurt am Main, Germany

Prof. Dr. Patrick Meybohm

Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine
University Hospital Würzburg,
Würzburg, Germany

Statistical Analysis:

Prof. Dr. Martin Posch

Lusine Yeghiazaryan

Daniela Boryshchuk

Section for Medical Statistics, CEMSIIS, Medical University of  Vienna
Währingerstraße 25a
1090 Vienna Austria