Oral or intravenous iron as an adjuvant to autologous blood donation in elective surgery: a randomized, controlled study

Weisbach, Volker; Skoda, P.; Rippel, R.; Lauer, Günter; Glaser, Anke; Zingsem, J.; Zimmermann, Robert; Eckstein, Reinhold

doi:10.1046/j.1537-2995.1999.39050465.x

Cited by 53 publications

(50 citation statements)

References 24 publications

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“…For patients subjected to more aggressive phlebotomy (up to 2 units weekly), the endogenous EPO response is more substantial [8][9][10][11]. In one clinical trial [9], a linear-logarithmic relationship was demonstrated between change in hemoglobin level and the endogenous EPO response [12].…”

Section: Efficacymentioning

confidence: 99%

“…The erythropoietic response that occurs under these conditions is therefore modest [5]. A summary of prospective, controlled trials of patients undergoing such blood loss via autologous phlebotomy is presented in Table 2 [6][7][8][9][10][11], along with calculated estimates of red blood cell (RBC) volume expansion (erythropoiesis in excess of basal rates). With routine PAD, erythropoiesis of 220-351 ml (11-19% RBC expansion) [6,7], or the equivalent of 1-1.75 blood units, occurs in excess of basal erythropoiesis, which indicates the efficacy of this blood conservation practice.…”

Section: Efficacymentioning

confidence: 99%

“…In one clinical trial [9], a linear-logarithmic relationship was demonstrated between change in hemoglobin level and the endogenous EPO response [12]. EPO-mediated erythropoiesis in this setting is 397-568 ml (19-26% RBC expansion) [8][9][10][11], or the equivalent of 2-3 blood units. When recombinant human EPO therapy is administered during PAD, the equivalent of 5 blood units is generated [10,13].…”

Section: Efficacymentioning

confidence: 99%

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Autologous Blood Donation

Goodnough

2005

Anesthesiology Clinics of North America

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Section: Efficacymentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

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Autologous Blood Donation

Goodnough

2005

Anesthesiology Clinics of North America

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“…This is probably related to the fact that both groups of patients that were included in PABD, immediately after blood collection, began with oral iron replacement, while the group that did not give blood did not receive pre-operative iron. According to Weisbach et al [20] for patients without iron deficiency before PABD, if intravenous or oral iron therapy is started it increases the success rate of PABD but does not reduce the need for allogeneic blood transfusions. According to Biesma et al [21] in PABD donors with normal levels of iron, iron compensation has no effect on erythropoiesis and is insufficient to maintain iron stores.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial

Blazekovic

Bićanić

Hrabač

et al. 2013

International Orthopaedics (SICOT)

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Purpose During total knee arthroplasty (TKA) blood loss can be significant and in spite of all techniques for reducing blood loss there is still a significant possibility for blood transfusions. For blood loss management during TKA, pre-operative autologous blood donation (PABD) is still a standard of care. In this prospective randomised study we have evaluated the efficacy of PABD in patients undergoing TKA to answer the question whether there is any need for autologous blood donations during TKA and, if yes, for which group of patients. Methods Patients were randomised to three groups. In group 1 patients did not donate autologous blood, in group 2 patients donated 1 dose 72 hours prior to TKA and in group 3 patients donated autologous blood 14 days prior to TKA. In all patients haemoglobin, haematocrit, thrombocyte and reticulocyte values, iron concentrations (Fe, unsaturated iron binding capacity, total iron binding capacity), activated partial thromboplastin time, prothrombin time, and intra-operative and postoperative blood loss were measured and compared. Results With PABD there was no reduction in allogeneic blood transfusions and a large number of taken doses of autologous blood was discarded, which significantly increased the cost of treatment for these patients. For patients undergoing TKA, PABD can provoke iatrogenic anaemia and thereby increase the likelihood of the need for allogeneic blood transfusion. Conclusions Results of our study showed that PABD in nonanaemic patients is not justified and is not economically feasible.

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“…6 Observations in blood donors show that erythropoiesis is only modestly stimulated after phlebotomy and does not improve with oral iron supplementation. 7,8 Furthermore, the degree to which erythropoiesis is stimulated is not dependent on the level of storage iron present. 9 This suggests that iron is not a limiting factor for haemoglobin recovery after acute blood loss in iron-replete individuals.…”

Section: Discussionmentioning

confidence: 99%

Iron Supplementation for Postoperative Anaemia Following Major Paediatric Orthopaedic Surgery

Lau

Utukuri

Ramachandran

et al. 2007

annals

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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.

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Oral or intravenous iron as an adjuvant to autologous blood donation in elective surgery: a randomized, controlled study

Abstract: In non-iron-deficient patients undergoing modest ABD without erythropoietin therapy, neither oral nor i.v. application of iron during the preoperative period enhances the success of preoperative ABD.

Cited by 53 publications

References 24 publications

Autologous Blood Donation

Autologous Blood Donation

Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial

Iron Supplementation for Postoperative Anaemia Following Major Paediatric Orthopaedic Surgery

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