Post-haemodilution anaemia in paediatric cardiac surgery: benefit of intravenous iron therapy

Editorial: Ann Fr Anesth Reanim
Fecha: 01/10/2005
Hulin S, Durandy Y.

Service de reanimation de chirurgie cardiaque pediatrique, institut cardiologique Paris-Sud, hopital Jacques-Cartier, avenue du Noyer-Lambert, 91300 Massy, France.

OBJECTIVE: Anaemia is the main complication following haemodilution in paediatric cardiac surgery. Iron oral therapy is ineffective to improve anaemia. The aim of this study is to assess the effect of a single dose of intravenous iron saccharate Venofer. STUDY DESIGN: Open, randomized. PATIENTS AND METHODS: 93 patients were randomized in two groups. The first one is the control group without iron supplementation and the second one received a 5 mg/kg injection of Venofer administered at day 1. Three biological factors were studied on day 1 and day 5 following surgery: haemoglobin, ferrritin and reticulocyte rate. Student test was used for statistical analysis of results. RESULTS: Age, weight, haemoglobin, ferritine and reticulocyte on day 1 were similar in both group (no significant difference). On day 5 ferritin was higher in the treated group 215+/-87 vs 101+/-55 mug/l in the non treated group (P<0.001). Reticulocyte rate was also higher in the treated group 3.25+/-1.16 vs 2.65+/-0.97% (P<0.005) in the untreated group. CONCLUSION: Postoperative systemic inflammation is probably the factor which impaired the effect of oral iron therapy. Parenteral iron may act by treating a functional iron deficiency and/or by increasing endogenous erythropoietin synthesis. Faster reversibility of anaemia following iron injection improves quality of the postoperative recovery.

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