Perioperative anaemia management: consensus statement on the role of intravenous iron

Abstract

A multidisciplinary panel of physicians was convened by Network for Advancement of Transfusion Alternatives to review the evidence on the efficacy and safety of i.v. iron administration to increase haemoglobin levels and reduce blood transfusion in patients undergoing surgery, and to develop a consensus statement on perioperative use of i.v. iron as a transfusion alternative. After conducting a systematic literature search to identify the relevant studies, critical evaluation of the evidence was performed and recommendations formulated using the Grades of Recommendation Assessment, Development and Evaluation Working Group methodology. Two randomized controlled trials (RCTs) and six observational studies in orthopaedic and cardiac surgery were evaluated. Overall, there was little benefit found for the use of i.v. iron. At best, i.v. iron supplementation was found to reduce the proportion of patients requiring transfusions and the number of transfused units in observational studies in orthopaedic surgery but not in cardiac surgery. The two RCTs had serious limitations and the six observational limited by the selection of the control groups. Thus, the quality of the available evidence is considered moderate to very low. For patients undergoing orthopaedic surgery and expected to develop severe postoperative anaemia, the panel suggests i.v. iron administration during the perioperative period (weak recommendation based on moderate/low-quality evidence). For all other types of surgery, no evidence-based recommendation can be made. The panel recommends that large, prospective, RCTs be undertaken to evaluate the efficacy and safety of i.v. iron administration in surgical patients. The implementation of some general good practice points is suggested.

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

“…Depending on the type of surgery, underlying disease and the definitions of anaemia, about 11% to 76% of surgical patients may present with pre-operative anaemia [3,4]. Recently, there has been increasing evidence to suggest that pre-operative anaemia can lead to an increased risk of peri-operative adverse outcomes such as increased post operative infections, increase the requirement for blood transfusion, increase of hospital Length of Stay (LoS) and increased overall morbidity and mortality [5][6][7].…”

Evidence and triggers for the transfusion of blood and blood products

“…Patients may also have vitamin B12 or folate deficiencies [18,29]. A retrospective observational study evaluating the characteristics of pre-operative anaemia in patients undergoing elective orthopaedic joint arthroplasty found that 64% of patients had a normochromic normocytic anaemia, 23% a hypochromic anaemia and 12% had other types of anaemia [30]. Acute pre-operative anaemia is uncommon in clinically stable elective cases, but is frequently associated with significant haemorrhage as occurs in obstetrics and following trauma [20].…”

Assessment and treatment of preoperative anemia: Continuing Professional Development

“…Par exemple, jusqu'à 75 % des patients se présentant pour une chirurgie non urgente peuvent être atteints d'anémie en période préopératoire, et près de 90 % des patients pourraient souffrir d'anémie après la chirurgie. 5 Chez une grande proportion de ces patients, l'anémie s'explique par une carence en fer ou par une maladie chronique. [6][7][8][9][10][11] En période peropératoire, l'anémie chronique est un facteur de risque d'anémie aiguë, qui survient fréquemment en raison d'une combinaison de perte aiguë de sang et d'hémodilution provoquée par la réanimation liquidienne (he´modilution).…”