The effect of intravenous iron on erythropoiesis in older people with hip fracture

Abstract

Background anaemia following hip fracture is common and associated with worse outcomes. Intravenous iron is a potential non-transfusion treatment for this anaemia and has been found to reduce transfusion rates in previous observational studies. There is good evidence for its use in elective surgical populations. Objective to examine the impact of intravenous iron on erythropoiesis following hip fracture. Design two-centre, assessor-blinded, randomised, controlled trial of patients with primary hip fracture and no contra-indications to intravenous iron. Method the intervention group received three doses of 200 mg iron sucrose over 30 min (Venofer, Vifor Pharma, Bagshot Park, UK) on three separate days. Primary outcome was reticulocyte count at day 7 after randomisation. Secondary outcomes included haemoglobin concentration, complications and discharge destination. Eighty participants were randomised. Results there was a statistically significantly greater absolute final reticulocyte count in the iron group (89.4 (78.9–101.3) × 109 cells l−1 (n = 39) vs. the control (72.2 (63.9–86.4)) × 109 cells l−1 (n = 41); P = 0.019; (mean (95% confidence intervals) of log-transformed data). There were no differences in final haemoglobin concentration (99.9 (95.7–104.2) vs. 102.0 (98.7–105.3) P = 0.454) or transfusion requirements in the first week (11 (28%) vs. 12 (29%); P = 0.899). Functional and safety outcomes were not different between the groups. Conclusions although intravenous iron does stimulate erythropoiesis following hip fracture in older people, the effect is too small and too late to affect transfusion rates. Trial Registry Numbers: ISRCTN:76424792; EuDRACT: 2011-003233-34.

Association between Intravenous Iron Therapy and Short-term Mortality Risk in Older Patients Undergoing Hip Fracture Surgery: An Observational Study

“…Thus, the patients who had hemoglobin measured between 14 to 30 days after surgery are probably not representative of the exact hemoglobin in this postoperative period of all the patients in our study. Nevertheless, when comparing our results with other studies we acknowledge that the results on whether perioperative IV iron signi cantly recovers the hgb postoperatively are con icting (24,28,29,(42)(43)(44)(45) (29). Additionally, we acknowledge that the hemoglobin recovery especially depends on when the hemoglobin is measured postoperatively as studies have shown that IV Monofer requires several weeks before the physiological effect on the hemoglobin level is measurable (24,44).…”

“…Contrarily, Moppett et al have found no bene t of three daily doses of IV iron on the hemoglobin recovery seven day postoperatively among older patients undergoing hip fracture surgery (29,30).…”

Preoperative Anemia Treatment With Intravenous Iron in Patients Undergoing Major Orthopedic Surgery: A Systematic Review

“…Moppett et al tracked cardiovascular complications, infectious complications, and 30-day mortality and found no significant differences between groups. 39 In absolute terms, IV iron receiving patients experienced a similar percentage of cardiovascular complications (9% vs 10%), reduced infectious complications (21% vs 29%), and increased 30-day mortality (10% vs 0%). Serrano-Trenas et al measured 30-day mortality, infection rates, and serious adverse events.…”

“…Moppett et al measured daily Hb from admission until 7 days after surgery. 39 They found no significant difference in Hb at any point during the study. The mean admission Hb was slightly lower in the IV iron sucrose arm at 12.24 versus 12.54 g/dL in the control arm patients.…”

“…Moppett et al found no significant reduction in ABT frequency between the group receiving IV iron sucrose and the control cohort. 39 A total of 28% of patients receiving IV iron sucrose were transfused while 29% of control patients were transfused. The mean number of units transfused was not reported in this study.…”