Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion

Abstract

Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion Muñoz, M; Breymann, C; García-Erce, J A; Gómez-Ramírez, S; Comin, J; Bisbe, E Muñoz, M; Breymann, C; García-Erce, J A; Gómez-Ramírez, S; Comin, J; Bisbe, E (2008 Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion Abstract Anaemia is a common condition among patients admitted to hospital medicosurgical departments, as well as in critically ill patients. Anaemia is more frequently due to absolute iron deficiency (e.g. chronic blood loss) or functional iron deficiency (e.g. chronic inflammatory states), with other causes being less frequent. In addition, preoperative anaemia is one of the major predictive factors for perioperative blood transfusion. In surgical patients, postoperative anaemia is mainly caused by perioperative blood loss, and it might be aggravated by inflammation-induced inhibition of erythropoietin and functional iron deficiency (a condition that cannot be corrected by the administration of oral iron). All these mechanisms may be involved in the anaemia of the critically ill. Intravenous iron administration seems to be safe, as very few severe side-effects were observed, and may result in hastened recovery from anaemia and lower transfusion requirements. However, it is noteworthy that many of the recommendations given for intravenous iron treatment are not supported by a high level of evidence and this must be borne in mind when making decisions regarding its application to a particular patient. Nonetheless, this also indicates the need for further large, randomized controlled trials on the safety and efficacy of intravenous iron for the treatment of anaemia in different clinical settings. Department of Internal Medicine, University Hospital Virgen de la Victoria, Málaga. Spain. 5Department of Cardiology, Hospital Mar-Esperanza, Barcelona, Spain. 6Department of Anaesthesiology, Hospital Mar-Esperanza, Barcelona, Spain. Correspondence:Prof. Manuel Muñoz.AWGE. AbstractAnaemia is common in medical, surgical and critically ill patients, mostly due to absolute or functional iron deficiency (e.g.chronic blood loss or chronic inflammatory states respectively). Other causes are less frequent. Its presence is predictive for perioperative blood transfusion. Postoperative anaemia is mainly caused by blood loss, and may be aggravated by inflammation-induced inhibition of erythropoietin and functional iron deficiency (not correctable by the administration of oral iron). All these mechanisms may be involved in the anaemia of the critically ill. Intravenous iron administration seems to be safe, with few severe side-effects, and may hasten recovery from anaemia and reduce transfusion requirements. All the same, many indications given for IV iron are not supported by much evidence, which must be borne in mind when making decisions for a particular patient. Thus we need large, randomized controlled trials on the safety and efficacy of IV iron for the trea...

Clinical Use of Intravenous Iron: Administration, Efficacy, and Safety

“…53 In a review of the efficacy and safety of IV IS as an alternative to blood transfusion in surgery, the authors concluded that IV IS was safe, hastened recovery from anemia, and decreased transfusion requirements. 54 IV IS has been shown in observational studies to reduce transfusion requirements in joint replacement, cardiac surgery, and colorectal cancer surgery. A summary of the data on IV iron in surgery is shown in Table 5.…”

From Bloodless Surgery to Patient Blood Management

“…69 However, some levels of functional iron deficiency due to the inflammatory inhibition of hematopoiesis may also be present and treatment with ESAs may also be needed, although limited evidence is available in surgical patients. 70 Throughout the care, particularly in the postoperative recovery period, allogeneic blood products should only be transfused when clear indication exists and according to the current transfusion guidelines. Transfusions for vague reasons (eg, to speed up recovery or because of fatigue) should be avoided as the associated risks are likely to outweigh any potential benefits.…”

Niedokrwistość i niedobór żelaza u chorych z niewydolnością serca — postępowanie diagnostyczne i terapeutyczne

“…Istnieją doniesienia, że długotrwała terapia żelazem wiąże się ze zwiększonym stężeniem wolnych rodników tlenowych i przewlekłą aktywacją układu odpornościo-wego, która może doprowadzić do uszkodzenia tkanek i stanowi czynnik ryzyka wystąpienia incydentów sercowo--naczyniowych [38]. Dalsze badania wykazały jednak podobną częstość działań niepożądanych w populacjach pacjentów z HF poddawanych leczeniu w porównaniu z grupami kontrolnymi [38].…”

“…Dalsze badania wykazały jednak podobną częstość działań niepożądanych w populacjach pacjentów z HF poddawanych leczeniu w porównaniu z grupami kontrolnymi [38]. Stosowanie żelaza dożylnie rzadko jest powiązane z ryzykiem wystąpienia reakcji uczuleniowej.…”