Role of intravenous iron in the treatment of anemia in patients with gastrointestinal tract tumors undergoing chemotherapy: a single-center, observational study

Lima, J Pedroso de; Gago, Patrícia; Rocha, Mariana; Grilo, I.; Gomes, Rosa; Luís, Michael; Sarmento, T.; Teira, A.; Sousa, Maria Kéren Ribeiro; Barbosa, Miguel

doi:10.2147/ijgm.s165947

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…All studies included a comparator arm, except for Bojesen et al [ 28 ], Lima et al [ 29 ] and, Verhaeghe et al [ 30 ] where all patients received IV iron. Of the RCTs, Keeler et al [ 31 ], Keeler et al [ 32 ], and Talboom et al [ 33 ] compared ferric carboxymaltose (FCM) to oral iron, while Laso-Morales et al [ 34 ] compared FCM to iron sucrose (IS), and Ng et al [ 35 ] compared iron isomaltoside to standard of care.…”

Section: Resultsmentioning

confidence: 99%

Intravenous iron and iron deficiency anemia in patients with gastrointestinal cancer: A systematic review

Nandakumar,

Singh,

Tharani

et al. 2024

PLoS ONE

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Background Iron deficiency anemia (IDA) is a prevalent hematological complication associated with gastrointestinal (GI) cancers due to an increased loss of iron and decreased iron absorption. The purpose of this systematic review is to evaluate the use of parenteral iron to treat IDA in patients with GI cancer. Methods PubMed, Cochrane, EMBASE, CINHAL and Scopus were searched from January 1, 2010 to September 29, 2023 with no language restrictions. We excluded editorials, case reports, abstracts, conference papers, and poster presentations. Studies were included if they discussed IDA, GI neoplasms, use of iron supplementation (with or without erythropoietin-stimulating agents [ESAs]), defined anemia and had an adult patient population. We assessed the efficacy of parenteral iron in comparison to other iron supplementation methods when treating IDA in patients with GI cancer. The Cochrane Risk of Bias Tool 2 (RoB 2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) assessment tools were used to assess the quality of the included studies. Moreover, the Cochrane Effective Practice and Organization data collection form was used to collect pertinent study information. Results Our search yielded 3,969 studies across all databases. Twenty-one studies were included (6 randomized control trials; 15 non-randomized studies). Of the 15 studies evaluating hemoglobin (Hb) response, seven studies found an increase in Hb levels when patients were treated with IV iron. The 14 studies evaluating red blood cell (RBC) transfusion rates found conflicting differences in RBC transfusion needs when treated with IV iron. Studies analyzing health related outcomes typically found an increase in quality of life and decreased post-operative complications. Discussion This review demonstrates improved outcomes of IDA in patients with GI cancer treated with IV iron instead of other iron supplementation methods. Timely diagnosis and appropriate IDA management can greatly improve quality of life in this patient population, especially if myelosuppressive chemotherapy is required.

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Section: Resultsmentioning

confidence: 99%

Intravenous iron and iron deficiency anemia in patients with gastrointestinal cancer: A systematic review

Nandakumar,

Singh,

Tharani

et al. 2024

PLoS ONE

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“…All studies included a comparator arm, except for Bojesen et al [22], Lima et al[23] and, Verhaeghe et al [24] where all patients received IV iron. Of the RCTs, Keeler et al [25] and Keeler et al [26] compared ferric carboxymaltose (FCM) to oral iron, while Laso-Morales et al [27] compared FCM to iron sucrose (IS), and Ng et al [28] compared iron isomaltoside to standard of care.…”

Section: Resultsmentioning

confidence: 99%

“…Bojesen et al [22] reported a mean increase in Hgb of 2.13 g/dL (95% CI: 1.71-2.55 g/dL; p <0.0001) after four weeks in CRC patients who received iron isomaltoside prior to surgery. In addition, Lima et al [23] reported an absolute increase in mean Hgb of 0.9 g/dL (SD 1.3) from baseline to 12-14 weeks ( p =0.001) in CRC patients who received 1000 mg of IV FCM (Ferinject™) every study visit (12-13 weeks) until anemia or ID was corrected. In contrast, Verhaeghe et al reported no significant increase in Hgb in patients with GI malignancies who received at least one dose of IV FCM preoperatively after a four week follow up period [24].…”

Section: Resultsmentioning

confidence: 99%

Intravenous iron and iron deficiency anemia in gastrointestinal cancer patients: a systematic review

Nandakumar,

Singh,

Remtulla Tharani

et al. 2023

Preprint

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Background Iron deficiency anemia (IDA) is a prevalent hematological complication associated with gastrointestinal (GI) cancers due to an increased loss of iron and decreased iron absorption. We estimated the efficacy of parenteral iron on hemoglobin levels, blood transfusion needs and overall quality of life in patients with GI malignancies. Methods In this systematic review, we used PubMed, Cochrane, EMBASE, CINHAL and Scopus to conduct an electronic search from January 1, 2010 to March 24, 2022 with no language or study design restrictions. Studies were included if they discussed IDA, GI neoplasms, use of iron supplementation (with or without erythropoietin-stimulating agents [ESAs]), defined anemia and had a patient population of adults. Studies were excluded if were published before 2010. We assessed the efficacy of parenteral iron in comparison to other iron supplementation methods when treating IDA in GI cancer patients. The Cochrane Risk of Bias Tool 2 (RoB 2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) assessment tools were used to assess the quality of the included studies. Moreover, the Cochrane Effective Practice and Organization data collection form was used to collect pertinent study information. Results Our search yielded 3,156 studies across all databases. With the exclusion of duplicates, ineligible study designs, as well as studies that did not pass abstract and full-text screening, 17 studies were included in our final analysis (4 randomized control trials; 13 non-randomized studies). Of the 13 studies evaluating hemoglobin (Hgb) response, seven studies found an increase in Hgb levels when patients were treated with IV iron. The 8 studies evaluating red blood cell (RBC) transfusion rates found no significant differences in RBC transfusion needs when treated with IV iron. Studies analyzing health related outcomes typically found an increase quality of life and decreased post-operative complications. Discussion This review reveals the improved outcomes of IDA in GI cancer patients treated with IV iron instead of other iron supplementation methods. Timely diagnosis and appropriate IDA management can greatly improve quality of life in this patient population, especially if myelosuppressive chemotherapy is required. Our systematic review presents some limitations due to heterogenous interventions in the randomized control trials, the varying time points of data collection in each study, and the use of small sample sizes.

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“…We have introduced our anaemia pathway to the early stages of our patient pathway in order to afford the greatest duration of time for haematopoesis; as a consequence, we have also treated patients who do not ultimately present to the operating theatre. These patients will still benefit from treatment of iron deficiency anaemia 18 20 21. The introduction of POC Hb testing has facilitated diagnosis and treatment of iron deficiency anaemia during a single preassessment clinic attendance.…”

Section: Lessons and Limitationsmentioning

confidence: 99%

Improving preoperative haemoglobin using a quality improvement approach to treat iron deficiency anaemia

2020

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Optimising preoperative haemoglobin (Hb) before elective surgery is recommended by the National Institute of Clinical Excellence. We have used a quality improvement (QI) approach to treat iron deficiency anaemia in patients presenting to the preoperative assessment clinic (PAC) before major elective oesophagogastric surgery. Through a series of three QI cycles, we have treated iron deficiency, improved preoperative haemoglobin (Hb) and reduced the rate of postoperative blood transfusion. Our methods have included the early diagnosis of iron deficiency at the PAC attendance, the development and implementation of a new clinical guideline on the treatment of preoperative anaemia and the introduction of a one-stop clinic facilitating same-day treatment with intravenous iron, where appropriate, in conjunction with comprehensive preoperative assessment. The incidence of severe preoperative anaemia (Hb<100 g/L) has fallen from 10% in 2014 to 1.6% in 2018. The overall incidence of preoperative anaemia (defined as Hb<130 g/L by international consensus statement) has reduced from 57.9% in 2014 to 43.9% in 2018. Blood transfusion rate has declined from 16% to 6.5% of patients between 2014 and 2018. In 2018, none of the patients who required a postoperative blood transfusion presented to theatre with preoperative anaemia, a significant change from prior to the interventions. There has been a reduction of 63% in the number of units transfused. The project has successfully optimised these patients, leading to improved preoperative Hb and reduced use of blood transfusion.

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Role of intravenous iron in the treatment of anemia in patients with gastrointestinal tract tumors undergoing chemotherapy: a single-center, observational study

Cited by 11 publications

References 18 publications

Intravenous iron and iron deficiency anemia in patients with gastrointestinal cancer: A systematic review

Intravenous iron and iron deficiency anemia in patients with gastrointestinal cancer: A systematic review

Intravenous iron and iron deficiency anemia in gastrointestinal cancer patients: a systematic review

Improving preoperative haemoglobin using a quality improvement approach to treat iron deficiency anaemia

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