Oral Ferrous Sulfate Does Not Increase Preoperative Hemoglobin in Patients Scheduled for Hip or Knee Arthroplasty

Editorial: Ann Pharmacother
Fecha: 01/06/2011
Kim Lachance, Michel Savoie, Maryse Bernard, Stéphanie Rochon, Josée Fafard, Robert Robitaille,
Pascal-André Vendittoli, Sylvie Lévesque, and Simon de Denus

BACKGROUND: Low hemoglobin (Hb) concentrations before lower limb joint
replacement are associated with the need for blood transfusions and increased
mortality. To optimize preoperative Hb, blood conservation protocols often
recommend oral iron supplements, even in nonanemic patients.
OBJECTIVE: To investigate the impact of ferrous sulfate on the change in Hb prior
to hip or knee arthroplasty and evaluate the effect of oral iron on hematocrit,
mean corpuscular volume (MCV), ferritin, and transferrin saturation, as well as its
tolerability and treatment adherence.
METHODS: We conducted a prospective, observational cohort study of adults with
Hb concentrations between 10 and 15 g/dL who received iron supplementation
prior to hip or knee arthroplasty. Systemic inflammatory diseases, vitamin B12 or
folate deficiency, and current use of iron supplements, intravenous iron, or
erythropoietin were exclusion criteria. All participants were prescribed ferrous
sulfate 300 mg 3 times daily for a minimum of 3 weeks. Complete blood cell
counts and iron studies were performed before therapy and surgery.
RESULTS: Eighty-seven patients with a mean (SD) Hb of 13.47 (0.84) g/dL were
included in the study. Preoperative Hb decreased after treatment with iron (–0.14
[0.53] g/dL, p = 0.015). Hematocrit also declined (–0.6% [1.8%], p = 0.002),
whereas ferritin increased (25.8 [38.6] ng/mL, p < 0.001). No significant change was seen in MCV and transferrin saturation. The most common adverse effects were constipation (33.3%), heartburn (13.8%), and abdominal pain (12.6%). The adherence rate was 67.1%. CONCLUSIONS: Oral ferrous sulfate supplementation is not an effective method to increase preoperative Hb in patients scheduled for hip or knee arthroplasty, and its use is associated with adverse effects.

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