Resolution of Cardiac Symptoms through Preoperative Intravenous Iron Supplementation in a Cancer Patient

Abstract

Cardiologic assessment was conducted on a 78-year-old male patient scheduled for elective aortic valve surgery who complained of angina and dyspnea that had arisen over the previous few months. Evaluation showed stable coronary artery disease and iron deficiency anemia (hemoglobin, 7.7 g/dL). Colonoscopy revealed a non-stenosing carcinoma of the right colonic flexure that was causing chronic blood loss. The interdisciplinary tumor board of the hospital decided that his need for an extended right hemicolectomy followed by resection of two pulmonary nodules that were suspicious of metastatic lesions had priority over his cardiac surgery. Prior to abdominal surgery, the patient received 4 × 500 mg intravenous iron (Ferric-Carboxymaltose) over 2 weeks, for correction of iron deficiency and optimization of hemoglobin concentration. This treatment led to rapid improvement of his angina and exertion-induced dyspnea. His hemoglobin concentration continued to rise even after completion of the iron supplementation, and reached normal levels before thoracoscopic removal of the lung nodules, which took place 1 month after resection of the colon tumor. The patient remained in good clinical condition without any need for blood transfusions. As follow-up visits showed persistent abatement of angina and dyspnea, aortic valve surgery and other cardiac interventions were no longer deemed necessary.