Preoperative iron deficiency increases transfusion requirements and fatigue in cardiac surgery patients

Piednoir, Pascale; Allou, Nicolas; Driss, Fathi; Longrois, Dan; Philip, Ivan; Beaumont, Carole; Montravers, Philippe; Lasocki, Sigismond

doi:10.1097/eja.0b013e32834ad97b

Cited by 77 publications

(101 citation statements)

References 23 publications

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“…88 In a study of 100 patients undergoing cardiac surgery, 37% had iron deficiency, defined as serum ferritin <80 μg/l, or 80-150 μg/l with TSAT <20%. 89 The group of patients with iron deficiency had a lower average age and higher female:male ratio than the group without iron deficiency. Relative to patients without iron deficiency, preoperative iron deficiency was associated with lower preoperative haemoglobin levels (P <0.006), higher perioperative transfusion rates during the first week (62% versus 35%; P <0.02), and higher scores of physical fatigue 7 days after surgery (P = 0.01).…”

Section: Iron In Nontransplant Cardiac Surgerymentioning

confidence: 98%

“…Relative to patients without iron deficiency, preoperative iron deficiency was associated with lower preoperative haemoglobin levels (P <0.006), higher perioperative transfusion rates during the first week (62% versus 35%; P <0.02), and higher scores of physical fatigue 7 days after surgery (P = 0.01). 89 Studies have also been conducted to investigate the value of oral or intravenous iron administration in patients undergoing cardiac surgery, primarily for the treatment of anaemia. In one double-blind trial, 120 patients were randomly assigned to a postoperative regimen of placebo, intravenous iron sucrose, or intravenous iron sucrose in combination with a single dose of erythropoietin.…”

Section: Iron In Nontransplant Cardiac Surgerymentioning

confidence: 99%

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Iron deficiency and cardiovascular disease

Haehling

Jankowska

Veldhuisen³

et al. 2015

Nat Rev Cardiol

251

151

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Iron deficiency affects up to one-third of the world's population, and is particularly common in elderly individuals and those with certain chronic diseases. Iron excess can be detrimental in cardiovascular illness, and research has now also brought anaemia and iron deficiency into the focus of cardiovascular medicine. Data indicate that iron deficiency has detrimental effects in patients with coronary artery disease, heart failure (HF), and pulmonary hypertension, and possibly in patients undergoing cardiac surgery. Around one-third of all patients with HF, and more than one-half of patients with pulmonary hypertension, are affected by iron deficiency. Patients with HF and iron deficiency have shown symptomatic improvements from intravenous iron administration, and some evidence suggests that these improvements occur irrespective of the presence of anaemia. Improved exercise capacity has been demonstrated after iron administration in patients with pulmonary hypertension. However, to avoid iron overload and T-cell activation, it seems that recipients of cardiac transplantations should not be treated with intravenous iron preparations.

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Section: Iron In Nontransplant Cardiac Surgerymentioning

confidence: 98%

Section: Iron In Nontransplant Cardiac Surgerymentioning

confidence: 99%

Iron deficiency and cardiovascular disease

Haehling

Jankowska

Veldhuisen³

et al. 2015

Nat Rev Cardiol

251

151

View full text Add to dashboard Cite

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“…These deficiencies may hamper preoperative Hb optimization and/or the recovery from postoperative anemia as well as increase postoperative morbidity. In 100 consecutive cardiac procedures, preoperative ID was frequent (37%), and it was associated with preoperative anemia, higher RBCT requirements, and postoperative fatigue [11]. In a retrospective cohort of 277 cardiac surgeries, prevalence of ID was 39%, and univariate analysis suggested that ID was associated with a longer hospital stay and fewer days alive out of hospital on postoperative day 90 [12].…”

Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

Management of Perioperative Iron Deficiency Anemia

et al. 2019

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Preoperative anemia affects 30–40% of patients undergoing major surgery and is an independent risk factor for perioperative blood transfusion, morbidity, and mortality. Absolute or functional iron deficiency is its leading cause. Nonanemic hematinic deficiencies are also prevalent and may hamper preoperative hemoglobin optimization and/or recovery from postoperative anemia. As modifiable risk factors, anemia and hematinic deficiencies should be detected and corrected prior to major surgical procedures. Postoperative anemia is even more common (up to 80–90%) due to surgery-associated blood loss, inflammation-induced blunted erythropoiesis, and/or preexisting anemia. Preoperative oral iron may have a role in mild-to-moderate anemia, provided there is sufficient time (6–8 weeks) and adequate tolerance of oral preparations. Postoperative oral iron is of little value and rife with gastrointestinal adverse events. Intravenous iron should preferentially be used in cases of moderate-to-severe iron deficiency anemia, concomitant use of erythropoiesis-stimulating agents, short time to surgery or nonelective procedures, and for postoperative anemia management. Minor infusion reactions to intravenous iron are rare, the incidence of severe anaphylactic reactions is extremely low, and there is no increase in infections with intravenous iron. Currently available intravenous iron formulations allowing administration of large single doses are preferred.

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“…18 Correcting IDA preoperatively through the use of oral or IV iron may be of benefit, especially in the elective orthopedic surgery population where there is ample time to correct preoperative anemia. 19 Oral iron is typically preferred over IV iron; however, IV iron is indicated for patients who cannot tolerate oral iron; those who are experiencing persistent iron losses; patients receiving EPO; those with iron malabsorption issues, including short bowel syndrome; and patients with a short timeline before surgery.…”

Section: Prehospitalization Settingmentioning

confidence: 99%

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

2016

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Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesis-stimulating agents, and erythropoietin.Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery patients were evaluated, provided they reported blood transfusion outcomes. Data Synthesis: A total of 9 prospective and retrospective studies and 1 meta-analysis were identified and included. In the preoperative setting, administration of oral iron, IV iron, or ESA alone or in combination to correct underlying anemia led to significantly reduced transfusion rates. Transfusion requirements were generally less with combination therapy (ESA + oral or IV iron). In the short-term perioperative or postoperative period, use of oral or IV iron led to conflicting results, with some reporting a statistically significant reduction in blood transfusions, whereas others reported none. Conclusions: In elective orthopedic surgery, IV or oral iron with or without an ESA may provide benefit in prevention of postoperative anemia and results in blood transfusion reduction without significantly increasing the risk of adverse events. These agents should be considered at the lowest effective dose with emphasis on administration prior to planned surgery.

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Preoperative iron deficiency increases transfusion requirements and fatigue in cardiac surgery patients

Abstract: Preoperative iron deficiency is frequent among cardiac surgery patients and is associated with anaemia, higher transfusion requirements and postoperative fatigue.

Cited by 77 publications

References 23 publications

Iron deficiency and cardiovascular disease

Iron deficiency and cardiovascular disease

Management of Perioperative Iron Deficiency Anemia

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

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