Iron Supplementation for Postoperative Anaemia Following Major Paediatric Orthopaedic Surgery

Abstract

Ann R Coll Surg Engl 2007; 89: 44-46 44Postoperative anaemia secondary to haemorrhage is a common complication following major surgery. Transfusion is best avoided particularly in children, due to the risks of infection, immunosuppression, and allo-immunisation, and is reserved for patients with severe anaemia. 1 Strategies that have been developed to reduce the severity of anaemia and minimise exposure to allogeneic blood transfusion include the use of erythropoietin, intra-operative cell salvage and autologous blood donation. 2Moderate anaemia following surgery is commonly treated empirically with iron.There has been an improved understanding of the pathophysiology and the role of iron in postoperative anaemia in the past decade. There is now strong evidence that the anaemia of surgery is not iron deficient and does not respond to iron supplementation. 3,4 Oral iron is generally safe but there are dose-dependent side-effects, particularly in children. 5 As it has been shown to be ineffective, its use cannot be recommended. Nevertheless, iron supplementation continues to be used in postoperative anaemia in various departments, including our own. This prompted us to undertake a national telephone survey of major paediatric orthopaedic surgical units in the UK to investigate the management of postoperative anaemia. Materials and MethodsWe conducted a telephone survey of the use of iron supplementation, blood transfusion, erythropoietin therapy and blood conservation techniques in the management of paediatric orthopaedic postoperative anaemia in the UK. Units which do not carry out major open hip, pelvis or spine surgery in children were excluded from this study. We interviewed middle-grade doctors (senior house officers and specialist registrars) and charge nurses at 23 major paediatric orthopaedic surgical centres. Using a structured questionnaire, we examined how postoperative anaemia is There is increasing evidence that the anaemia of surgery is not iron deficient and is, therefore, unresponsive to iron supplementation. Oral iron is best avoided postoperatively, particularly in children, due to its dose-dependent side effects. We undertook a national survey of major paediatric orthopaedic surgical units in the UK to investigate the current management of postoperative anaemia with particular reference to iron supplementation.