Pre-Operative Oral Iron Supplementation Reduces Blood Transfusion in Colorectal Surgery – A Prospective, Randomised, Controlled Trial

Abstract

Ann R Coll Surg Engl 2007; 89: 418-421 418Colorectal cancer is the third most common cancer in the UK. 1 Rates of peri-operative transfusion ranging from 20-75% have been reported in patients undergoing colorectal resection. 2,3Despite innovations in transfusion medicine, peri-operative transfusion of allogeneic blood components has inherent risks including immunomodulation, transmission of disease, allergic reaction, and allo-immunisation. More recently, the introduction of leukocyte-depleted blood has led to an increased cost pressure on health resources.Studies have shown that predictors of increased perioperative transfusion are proximal tumours, increasing tumour size, operative blood loss and pre-operative anaemia. 2,4,5Pre-operative anaemia is a frequent finding in this group of surgical patients and accounts for a substantial number of blood transfusions. Defining anaemia as a haemoglobin of less than 13.5 g/dl in men and 11.5 g/dl in women, locally recorded data from the preceding years' 223 surgical colorectal cancer patients demonstrated that 51% of men and 25% of women were anaemic (38% combined) on admission. The overall transfusion rate in the men and women was 28% and 41%, respectively, whereas in the anaemic patients it was 39% and 68%, respectively.The aim of this study was to assess whether pre-operative oral iron therapy would decrease pre-operative anaemia and, thereby, reduce the incidence of peri-operative transfusion. Patients and MethodsThe study received approval from the Plymouth Healthcare Trust Local Research Ethics Committee.Patients diagnosed with colorectal cancer were identified in out-patient clinics. All patients fit for surgery were SURGICAL ONCOLOGYAnn R Coll Surg Engl 2007; 89: 418-

Short course pre-operative ferrous sulphate supplementation – is it worthwhile in patients with colorectal cancer?

“…The iron group were less likely to require an intra-operative transfusion. Lidder et al 12 randomised 45 patients to receive iron supplementation for 2 weeks prior to surgery. This reduced transfusion rate in the intervention group.…”

Single Dose Preoperative Administration of Intravenous Iron Corrects Iron Deficiency Anaemia in Colorectal Cancer

“…In Edwards study only nine patients in each group had a below normal haemoglobin, and in these patients receiving intravenous iron the mean ferritin was 100.5ng/ml with a mean transferrin saturation of 11.0%. The parameters listed in the iron intervention group represent a phenotype more consistent with functional iron deficiency or reticuloendothelial blockade [3]. Current British Society of Gastroenterology guidelines recommend using a ferritin of <50ng/ml to define iron deficiency in the face of co-existing disease, [13] thus suggesting that very few of the patients recruited were actually iron deficient and unlikely to respond to any form of iron supplementation.…”

“…Treatment of IDA is associated with a reduction in the need for blood transfusion in the perioperative period [3]. Treatment strategies include iron supplementation via either an enteral or parenteral route.…”

Perioperative Implications of Neoadjuvant Therapies and Optimization Strategies for Cancer Surgery

“…Evidence shows that extensive pre and postoperative nutritional supplementation via enteral and parenteral routes improves surgical outcomes [63][64][65]. Furthermore, preoperative iron supplementation in the anemic patient has been shown to reduce blood transfusion, raise preoperative hemoglobin levels, improve peak VO 2 at CPET [66], and reduce immune suppression [67]. Clinical evidence demonstrates that preoperative exercise prescription as well as immune-nutritional and psychological support improves postoperative functional recovery in patients having lung cancer surgery [68,69], colorectal, and abdominal surgery [59,70].…”