Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia

Abstract

Purpose:To determine if early recovery from severe postoperative anemia is accelerated by iv iron therapy alone or in combination with recombinant erythropoietin (EPO). Methods:In this double-blinded, placebo-controlled randomized study, consenting adult patients without preoperative anemia whose hemoglobin concentration (Hb) was 70 to 90 g·L -1 on the first day after cardiac or orthopedic surgery (POD 1) were assigned to one of three groups: control, iv iron alone (200 mg of iron sucrose on POD 1, 2, and 3) or in combination with EPO (600 U·kg -1 on POD 1 and 3). The primary outcome was increase in Hb (adjusted for red blood cell transfusions) from POD 1 to 7. Analysis was by intention-to-treat in patients for whom the primary outcome was available. Group effect was analyzed by the ANOVA test, and between-group differences were specified with a Duncan multiple-range test. Results:The primary outcome was available in 31 of 38 randomized patients. The average POD 1 Hb was 84 ± 4 g·L -1 . There were no between-group differences in outcomes except for higher reticulocyte counts on POD-7 in the combination group. The average adjusted one-week increases in Hb were 7 ± 8 g·L -1 in the control group (n = 10), 9 ± 9 g·L -1 in the iv iron group (n = 11), and 10 ± 14 g·L -1 in the combination group (n = 10). The average adjusted six-week increases in Hb were 37 ± 14 g·L -1 in the control group, 40 ± 7 g·L -1 in the iv iron group, and 45 ± 12 g·L -1 in the combination group. Conclusion:Early postoperative treatment with iv iron alone or in combination with EPO does not appear to accelerate early recovery from postoperative anemia.

Efficacy and Safety of Iron Supplementation for the Elderly Patients Undergoing Hip or Knee Surgery: A Meta-Analysis of Randomized Controlled Trials

“…Subsequent review of the abstracts produced eight articles that were retrieved for more detailed evaluation. One study was excluded because of its special subjects in orthopedic and cardiac surgery [20], and another was excluded for its design in investigating iron therapy versus folic acid, which may also raise hemoglobin level [21]. Therefore, six studies were determined to be appropriate for this meta-analysis (Fig.…”

Effects of intravenous iron combined with low‐dose recombinant human erythropoietin on transfusion requirements in iron‐deficient patients undergoing bilateral total knee replacement arthroplasty (CME)

“…The combined use of parenteral iron and rHuEPO has been tried in a number of clinical settings, 10,11 including augmentation of PABD or increasing preoperative hemoglobin (Hb) levels 12,13 . However, the efficacy of this regimen remains controversial 14‐16 . The authors suppose that disparate results are due to the doses used, the timing of treatment, the coadministration of iron or rHuEPO, patient iron status, and type of surgery.…”

Iron sucrose – characteristics, efficacy and regulatory aspects of an established treatment of iron deficiency and iron-deficiency anemia in a broad range of therapeutic areas

“…IS 200 mg on days 1, 2 and 3, and the same schedule of i.v. IS plus rHuEPO 600 U/kg on days 1 and 3 post-surgery [72]. Hb values on day 7 as well as 6 weeks after surgery were not different in the three groups.…”