Very‐short‐term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients

Múñoz, Manuel; Gómez‐Ramírez, Susana; Cuenca, Jorge; García-Erce, José Antonio; Iglesias-Aparicio, Daniel; Haman-Alcober, Sami; Ariza, Daniel; Naveira, E.

doi:10.1111/trf.12195

Cited by 173 publications

(153 citation statements)

References 49 publications

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“…No standard dose exists in this setting; however, total doses of 200 to 600 mg of iron sucrose (100-200 mg every 48 hours for 2-3 doses beginning on the day of admission) perioperatively have been reported in studies focusing on IV iron. [26][27][28][29][30][31] Studies typically did not report baseline iron labs; however, 1 trial specified that patients had nearnormal iron levels (46.3-53.2 µg/dL), with no significant difference between groups as well as normal ferritin and transferrin levels. 26 No difference has been shown in blood transfusion rates (percentage of patients receiving a transfusion) in studies that compared patients receiving IV iron alone administered throughout the preoperative and postoperative periods with patients not receiving iron.…”

Section: Perioperative 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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Section: Perioperative Settingmentioning

confidence: 99%

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

2016

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“…Over 70% of anemic patients presented with ID or functional ID (FID), resulting in iron-restricted erythropoiesis (IRE) [7]. As for nonelective procedures, up to 75% of patients undergoing hip fracture repair surgery ( n = 1,004) presented with Hb <13 g/dL on admission [8]. …”

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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“…For adults, transplantation using two cord units is frequently necessary [3][4][5] and literature demonstrates that double umbilical cord blood transplantation (DUCT) yields durable remissions [1,5,6]. Data on DUCT in hepatosplenic gamma-delta T-cell lymphoma with hemophagocytic lymphohistiocytosis (HLH) are limited to case reports [7,8]. We describe a 22-year-old woman with hepatosplenic gamma-delta lymphoma with hemophagocytosis treated with DUCT.…”

Section: Author Contributionsmentioning

confidence: 99%

“…In a pooled analysis of 2,547 perioperative patients who underwent either hip fracture repair or lower limb arthroplasty, Munoz et al reported a decrement in transfusion rate from 48.8 to 32.4% in those who received perioperative intravenous iron versus those who did not [7]. Postoperative infections were reduced from 26.9 to 10.7%, length of stay from 13.4 to 11.9 days and remarkably thirty day mortality from 9.4 to 4.8% in the IV iron group.…”

mentioning

confidence: 99%

Factors affecting outcome of allogeneic stem cell transplantation as salvage in patients with acute myeloid leukemia primary refractory to intensive induction therapy

et al. 2014

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Very‐short‐term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients

Cited by 173 publications

References 49 publications

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

Management of Perioperative Iron Deficiency Anemia

Factors affecting outcome of allogeneic stem cell transplantation as salvage in patients with acute myeloid leukemia primary refractory to intensive induction therapy

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