Perisurgical Intravenous Iron Therapy

Abstract

SUMMARY There is no doubt that the developments in detecting viral antigens and antibodies, and very recently viral RNA or DNA, in donor blood, have greatly increased the safety of blood transfusion1. However, while it is generally agreed that a residual risk of transmitting viral infections by blood still exists 2, we do not know if Creutzfeld‐Jakob disease or its new form – undetectable with current screening methods – are transmitted by transfusion or not 3. Furthermore, the long‐term immunomodulatory effect of allogeneic blood on the patient is not known. For these reasons, a more conservative transfusion practice is advocated; physicians must do all they can to decrease allogeneic blood transfusion, especially in patients without blood disease who, because of a significant acute blood loss (e.g. during major surgery), are likely to receive allogeneic blood. In this paper we will discuss the use of intravenously administered iron in the perisurgical setting as a means of accelerating erythropoiesis in an attempt to decrease transfusion requirements.

The effect of intravenous and oral iron administration on perioperative anaemia and transfusion requirements in patients undergoing elective cardiac surgery: a randomized clinical trial

“…Recently, some authors have suggested a role for intravenous iron in correcting anaemia after orthopaedic and oncological surgery, and in renal and obstetrics patients [10][11][12], but this remains controversial in cardiac surgery [13,14].…”

“…Anaphylactic reactions have been reported after the administration of intravenous iron dextrane [15]. Venofer ® (iron(III)-hydroxide sucrose) is a new intravenous preparation with very few reported side effects [10,11,16].…”

A comparative study of ferric carboxymaltose and iron sucrose as a parenteral iron treatment in iron deficiency anemia during pregnancy in a tertiary care hospital

“…Therefore, guidelines recommend that physicians consider intravenous (iv) iron administration in pregnant women in case of severe iron deficiency anemia (Hb -9.0 g/ dL), intolerability to oral iron, insufficient Hb increase after oral iron treatment or if there is a need for rapid Hb reconstitution. 9,10 Parenteral therapy promises a better response in anemic patients and can obviate the need for blood transfusions in the antenatal and postpartum period. 11 The most commonly used intravenous (iv) iron preparation is iron sucrose.…”