Iron metabolism and erythropoiesis after surgery

Iperen, Charlotte E. van; Kraaijenhagen, Rob J.; Biesma, Douwe H.; Béguin, Yves; Marx, Joannes J.M.; Wiel, A. van de

doi:10.1046/j.1365-2168.1998.00571.x

Cited by 135 publications

(130 citation statements)

References 31 publications

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“…8 A similar study by van Iperen et al had similar findings. 7 In a randomized controlled study examining treatments for postoperative anemia (see below for details of this study), Madi-Jebara et al found that, in their control group in whom the average postoperative Hb was 108 ± 13 g·L -1 , there was no correction of anemia by two-weeks after surgery, and there was only a one-third correction of anemia at four-weeks after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on less severe degrees of postoperative anemia have found that correction of the anemia is slow, owing to the inflammatory effects of surgery on iron metabolism and erythropoietin response to anemia. 7,8 In the observational study by Biesma et al, which included orthopedic surgery patients without preexisting anemia (average Hb = 141 ± 11 g·L -1 ) who developed postoperative anemia with an average Hb of 111 ± 13 g·L -1 , there was no correction of anemia by one-week ) rise 10 ± 9 12 ± 6 14 ± 10 6-week Hb (g·L after surgery, while by two and six weeks after surgery there was a one-third and two-thirds correction of anemia, respectively. 8 A similar study by van Iperen et al had similar findings.…”

Section: Discussionmentioning

confidence: 99%

“…One is dietary iron supplementation; however, its effectiveness for this indication is, at best, minimal. 7,8,10,11 Two other therapies are iv iron therapy and recombinant erythropoietin therapy, both of which are effective in treating other types of anemia that have similar pathophysiological features to postoperative anemia, such as anemia of chronic diseases. The efficacy of these therapies in treating postoperative anemia, however, has not been appropriately assessed through randomized controlled clinical trials.…”

Section: Résultatsmentioning

confidence: 99%

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Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia

Karkouti

McCluskey

Ghannam

et al. 2006

Can J Anesth/J Can Anesth

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Résultatsmentioning

confidence: 99%

See 1 more Smart Citation

Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia

Karkouti

McCluskey

Ghannam

et al. 2006

Can J Anesth/J Can Anesth

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“…24,25 In critically ill patients, the body's erythropoietic response to anaemia is blunted as a consequence of diminished iron availability and the direct inhibitory effects of inflammatory cytokines. 26 Several studies have assessed the correlation between lower preoperative HTC level and worse outcome in surgical patients.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Haematocrit and Outcome in Critically Ill Surgical Patients

et al. 2017

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Haematocrit has been studied as an outcome predictor. The aim of this study was to evaluate the correlation between low haematocrit at surgical intensive care unit admission and high disease scoring system score and early outcomes. Material and Methods: This retrospective study included 4398 patients admitted to the surgical intensive care unit between January 2006 and July 2013. Acute physiology and chronic health evaluation and simplified acute physiology score II values were calculated and all variables entered as parameters were evaluated independently. Patients were classified as haematocrit if they had a haematocrit < 30% at surgical intensive care unit admission. The correlation between admission haematocrit and outcome was evaluated by univariate analysis and linear regression.Results: A total of 1126 (25.6%) patients had haematocrit. These patients had higher rates of major cardiac events (4% vs 1.9%, p < 0.001), acute renal failure (11.5% vs 4.7%, p < 0.001), and mortality during surgical intensive care unit stay (3% vs 0.8%, p < 0.001) and hospital stay (12% vs 5.9%, p < 0.001). Discussion: A haematocrit level < 30% at surgical intensive care unit admission was frequent and appears to be a predictor for poorer outcome in critical surgical patients. Conclusion:Patients with haematocrit had longer surgical intensive care unit and hospital stay lengths, more postoperative complications, and higher surgical intensive care unit and hospital mortality rates.

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“…The increases in serum ferritin were smaller than those found for acute infection. After surgery there was a rapid decline (in 2 days) in the concentration of haemoglobin, serum iron and transferrin, with the greatest fall shown by serum iron (57). The concentration of C-reactive protein (CRP) rose less rapidly from <5 mg/l to over 100 mg/l, reaching a maximum value at 5 days, and then declined to normal values over the subsequent 4 weeks.…”

Section: Serum Ferritin In Acute and Chronic Diseasementioning

confidence: 99%