The Important Role for Intravenous Iron in Perioperative Patient Blood Management in Major Abdominal Surgery

Short‐term effect of preoperative intravenous iron therapy in colorectal cancer patients with anemia: results of a cohort study

“…Therefore, compared to oral iron, intravenous (IV) iron therapy is likely to be more effective in treating anemia, as shown in patients undergoing orthopedic 18 or general abdominal surgery. 19 Based on these advantages, over the course of the past 5 years administration of IV iron has also been introduced in our institution. In this study, we retrospectively compare preoperative IV iron with usual care (UC; i.e., no iron therapy) in colorectal cancer patients with anemia, with regard to increasing preoperative Hb level, and reducing postoperative complications and blood transfusions.…”

Perioperative Anemia Management

“…39,40 A Cochrane review on preoperative anemia management with iron shows insufficient high-quality evidence to indicate benefit of preoperative parenteral iron treatment, 41 with only two small RCTs; Froessler et al randomized 72 patients to demonstrate a reduction in blood transfusion (12 vs. 31%) but no difference was noted in morbidity, mortality, or quality of life. 42 In comparison, the IV iron in colorectal cancer associated anemia (IVICA) group analyzed 116 patients undergoing colorectal surgery and found that parenteral iron therapy did not reduce blood transfusion requirement compared with those taking oral iron treatment. 43 However, those who receive IV iron were less fatigued and had increased quality of life at follow-up.…”

Cornerstones of patient blood management in surgery

“…A systematic review of patients with anaemia undergoing surgery (including orthopaedics, colorectal, gynaecology, spinal, cardiac, upper GI and head and neck) demonstrated an increase in the haemoglobin concentration and reduced to 0·88] with intravenous iron, especially when used with erythropoiesis-stimulating agents (ESAs) or in patients with lower ferritin concentration, without significant difference in mortality or severe adverse events (Lin et al, 2013). Two recent surgical trials involving the use of IV iron to treat pre-operative anaemia in patients undergoing colorectal and unspecified abdominal surgeries have shown conflicting responses in terms of transfusion outcomes (Froessler et al, 2016;Keeler et al, 2017). A trial by Froessler and his colleagues shows a significant reduction in RBC transfusion use by 60% in patients treated with IV iron pre-operatively (Froessler et al, 2016).…”

“…Two recent surgical trials involving the use of IV iron to treat pre‐operative anaemia in patients undergoing colorectal and unspecified abdominal surgeries have shown conflicting responses in terms of transfusion outcomes (Froessler et al, ; Keeler et al, ). A trial by Froessler and his colleagues shows a significant reduction in RBC transfusion use by 60% in patients treated with IV iron pre‐operatively (Froessler et al, ). No difference was observed in secondary outcomes in terms of morbidity, mortality and quality of life, which is likely due to small sample size.…”