Randomized clinical trial of preoperative intravenous iron sucrose to reduce blood transfusion in anaemic patients after colorectal cancer surgery

Edwards, Tansy; Noble, Emma; Durran, A.; Mellor, Neil; Hosie, K. B.

doi:10.1002/bjs.6688

Cited by 93 publications

(94 citation statements)

References 27 publications

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“…These results support those previously reported by Munoz et al who demonstrated improvement in haemoglobin concentration in 30 colorectal cancer patients receiving preoperative iron sucrose (200 mg/ twice a week; 4-8 sessions) [7]. In contrast [11] concluded, that there is no support for intravenous iron sucrose as a preoperative adjunct in colorectal adenocarcinoma to increase haemoglobin levels. However, concerns regarding the study design and the ability to justify these conclusions have been raised [12].…”

Section: Discussionsupporting

confidence: 90%

Single Dose Preoperative Administration of Intravenous Iron Corrects Iron Deficiency Anaemia in Colorectal Cancer

Ng¹

2010

J Blood Disord Transfus

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Preoperative iron defi ciency anaemia (IDA) is common and associated with poor postoperative outcomes. Standard treatment includes allogenic blood transfusion or oral iron supplementation, but new intravenous iron strategies have shown promise in the perioperative setting. We aim to assess the feasibility and effect of a single dose of intravenous iron in treating preoperative colorectal cancer related anaemia.We performed an open labelled phase I uncontrolled trial. Patients with a diagnosis of colorectal cancer and biochemically proven IDA received intravenous iron a minimum of 14 days prior to surgery. Blood parameters including haemoglobin values were measured at pre-dose and preoperative time points.Eight of the ten patients responded to intravenous iron supplementation with a mean preoperative rise in haemoglobin of 1.1 g/dl (p=0.036). Ferritin levels rose by a mean of 523.4ng/ml across the ten patients. No adverse events occurred in any of the trial patients.This trial demonstrates that intravenous iron is both a feasible and effective treatment for IDA in anaemic colorectal cancer patients. However two patients did not respond to treatment, highlighting the need to identify biochemical markers which will accurately predict the underlying cause for anaemia and response to treatment.

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Section: Discussionsupporting

confidence: 90%

Single Dose Preoperative Administration of Intravenous Iron Corrects Iron Deficiency Anaemia in Colorectal Cancer

Ng¹

2010

J Blood Disord Transfus

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“…68 A small study of intra-and postoperative intravenous iron and erythropoietin administration in patients undergoing elective bilateral total knee replacement also showed favourable results on reducing postoperative transfusions in the six weeks following surgery. 69 In elective colorectal 70 and gynaecological 71 surgical populations, contradictory results exist regarding the impact of intravenous iron in improving postoperative haemoglobin. The timing of iron administration in these studies differed (iron administered two weeks earlier in the hysterectomy study) which may account for the discrepancy in results with no benefit on postoperative haemoglobin seen in the colorectal group.…”

Section: Elective Surgerymentioning

confidence: 99%

Anaemia in the older surgical patient: a review of prevalence, causes, implications and management

et al. 2013

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SummaryThis review provides the clinician with a summary of the causes, implications and potential treatments for the management of anaemia in the older surgical patient. The prevalence of anaemia increases with age and is frequently identified in older surgical patients. Anaemia is associated with increased postoperative morbidity and mortality. Allogenic blood transfusion is commonly used to treat anaemia but involves inherent risks and may worsen outcomes. Various strategies for the correction of preand postoperative anaemia have evolved. These include correction of nutritional deficiencies and the use of intravenous iron and erythropoesis stimulating therapy. Clear differences exist between the elective and emergency surgical populations and the translation of research findings into these individual clinical settings requires more work. This should lead to a standardized approach to the management of this frequently encountered clinical scenario.

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“…In contrast, a recent randomised controlled trial comparing intravenous iron sucrose with placebo in the treatment of colorectal cancer-induced anaemia, reported no difference and no rise in pre-operative Hb and thus no benefit with iron sucrose in blood transfusion reduction [18]. In this study, 62 patients were randomised with 34 receiving 600mg of Venofer® in two divided doses of 300mg no less than 24hrs apart given a minimum of 15 days prior to surgery (average number of days or range was not stated in the article) [18].…”

Section: Discussionmentioning

confidence: 90%

“…In this study, 62 patients were randomised with 34 receiving 600mg of Venofer® in two divided doses of 300mg no less than 24hrs apart given a minimum of 15 days prior to surgery (average number of days or range was not stated in the article) [18]. Our dosing regimen for Venofer,® as recommended by the manufacturer, involves 100mg up to 3 times a week up to a maximum of 12 cycles.…”

Section: Discussionmentioning

confidence: 99%

Optimal Iron Replacement for Colorectal Cancer-Induced Anaemia

Alexander¹

2010

TOCOLCJ

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Abstract:Introduction: Iron deficiency anaemia (IDA) is commonly a result of colorectal cancer. Higher preoperative haemoglobin (Hb) is associated with an improved post-operative survival. The endpoint of normalising patients Hb is to reduce the need for perioperative blood transfusion which has oncological, safety and economic benefits. Methods:This study aims to compare the overall effect and cost between oral iron and two forms of parenteral iron, in raising the Hb of 53 consecutive colorectal cancer patients with IDA. The pre-and post-treatment Hb were measuring over time for oral and two formulations of parenteral iron (CosmoFer® and Venofer®), as were the need for supplemental pre-operative blood transfusions. The Total Hb rise and Hb rise/day were calculated as was the overall cost (including blood transfusions) in each of the three iron supplementation groups.Results: Both total Hb rise and Hb rise/day were significantly higher in the Venofer® (p=0.048, p=0.002) and CosmoFer® groups (p=0.034 & p=0.001) over oral iron. The oral iron group required significantly more blood than the Venofer® (p=0.04) and CosmoFer® groups (p=0.01). Although there was a trend for oral iron to cost more than parenteral, this did not reach significance.Conclusions: This study suggests that the end point of transfusion reduction is possible by the increased Hb rise rate of Venofer® or CosmoFer®. In addition, parenteral iron supplementation is no more costly than the traditional oral route, taking into account blood transfusion requirement.

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Randomized clinical trial of preoperative intravenous iron sucrose to reduce blood transfusion in anaemic patients after colorectal cancer surgery

Cited by 93 publications

References 27 publications

Single Dose Preoperative Administration of Intravenous Iron Corrects Iron Deficiency Anaemia in Colorectal Cancer

Single Dose Preoperative Administration of Intravenous Iron Corrects Iron Deficiency Anaemia in Colorectal Cancer

Anaemia in the older surgical patient: a review of prevalence, causes, implications and management

Optimal Iron Replacement for Colorectal Cancer-Induced Anaemia

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