{"id":422,"date":"2012-03-01T00:00:01","date_gmt":"2012-03-01T00:00:01","guid":{"rendered":"https:\/\/awge.doctime.es\/?p=422"},"modified":"2016-05-24T08:20:40","modified_gmt":"2016-05-24T06:20:40","slug":"awge-44","status":"publish","type":"post","link":"https:\/\/awge.doctime.es\/index.php\/2012\/03\/01\/awge-44\/","title":{"rendered":"Effects of postoperative intravenous iron on transfusion requirements after lower limb arthroplasty."},"content":{"rendered":"<p>Br J Anaesth.<br \/>\nMu\u00f1oz M, Naveira E, Seara J, Cordero J.<br \/>\n<a href='http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22337966' target='_blank'>Acceso al enlace publicador<\/a><\/p>\n<p>Preoperative anaemia is one of the major predictive<br \/>\nfactors for allogeneic blood transfusion (ABT) in surgical procedures with moderate-to-high perioperative blood loss.<br \/>\nTherefore, in major elective surgery, preoperative identification and evaluation of anaemia must be made early<br \/>\nenough to implement the appropriate treatment.1 In thisregard, preoperative i.v. iron has been shown to rapidly increase<br \/>\nhaemoglobin levels and reduce ABT requirements,<br \/>\nwithout serious side-effects.2 Similarly, perioperative i.v.<br \/>\niron, with or without erythropoietin, plus a restrictive<br \/>\ntransfusion protocol has been shown to reduce ABT requirements<br \/>\nafter elective and non-elective orthopaedic<br \/>\nsurgery.3\u20135 Data on the efficacy of postoperative i.v. iron in<br \/>\northopaedic surgical patients are, however, contradictory.6 7<br \/>\nThis and other evidence has been analysed in a consensus<br \/>\nstatement which suggests the perioperative administration<br \/>\nof i.v. iron in patients undergoing orthopaedic surgery with<br \/>\nhigh risk for developing severe postoperative anaemia.8<br \/>\nWe, therefore, read with great interest the report by<br \/>\nHo\u00a8nemann and colleagues9 on the successful use of i.v.<br \/>\nferric carboxymaltose (FCM) for treating severe anaemia,<br \/>\nafter volume therapy and surgery, in a young trauma<br \/>\npatient who refused ABT. However, patients who are older<br \/>\nand\/or present with less severe postoperative anaemia may<br \/>\nalso benefit from postoperative i.v. iron therapy, and we<br \/>\npresent here our experience in 114 consecutive patients<br \/>\nwho underwent total lower limb arthroplasty and were at<br \/>\nrisk for ABT (Hb,10 g dl21 on postoperative day 1).<br \/>\nAll patients were operated on by the same surgical team,<br \/>\nusing the same implants, and received the same antibiotic<br \/>\nand antithrombotic prophylaxis and postoperative management.<br \/>\nPatients received 100 mg day21 i.v. iron sucrose for<br \/>\nthree consecutive days (300 mg) (n\u00bc32), 200 mg day21 i.v.<br \/>\niron sucrose for three consecutive days (600 mg) (n\u00bc56),<br \/>\n600 mg i.v. FCM on postoperative day 1 (n\u00bc7), or no iron<br \/>\n(control, n\u00bc19). The limited physiological reserve and the<br \/>\nhigher prevalence of unrecognized cardiovascular disease<br \/>\nmay render this elderly patient population more vulnerable<br \/>\nto acute postoperative anaemia and, therefore, ABT was<br \/>\ngiven if postoperative Hb was ,8 g dl21 or there were clinical symptoms of acute anaemia (Hb ,9 g dl21 for patients with active cardiac disease). There were no differences between groups regarding age, gender distribution, co-morbidity, or surgical procedure, but preoperative Hb was slightly lower in the 300 mg i.v. iron group (Table 1). Overall, patients receiving 600 mg i.v. iron showed lower ABT rate and index (without differences in pre-ABT Hb levels) (Table 1). No differences in perioperative data were observed between patients receiving 600 mg iron sucrose or 600 mg FCM (data not shown). In addition, patients receiving 600 mg also had<br \/>\nlower postoperative infection rate and shorter length of hospital stay, suggesting that i.v. iron may have direct effects on body physical and functional performance, beyond those on erythropoiesis.10 No clinically meaningful adverse side effects of i.v. iron were noted.<br \/>\nIn conclusion, postoperative administration of 600 mg of<br \/>\ni.v. iron seems to be safe, and more effective than that of<br \/>\n300 mg to reduce ABT requirements in patients at risk. A randomized controlled trial to confirm the efficacy of postoperative FCM in orthopaedic patients is currently ongoing(EudraCT 2010-023038-22).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Br J Anaesth. Mu\u00f1oz M, Naveira E, Seara J, Cordero J. Acceso al enlace publicador Preoperative anaemia is one of<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[4],"tags":[],"_links":{"self":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts\/422"}],"collection":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/comments?post=422"}],"version-history":[{"count":1,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts\/422\/revisions"}],"predecessor-version":[{"id":660,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts\/422\/revisions\/660"}],"wp:attachment":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/media?parent=422"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/categories?post=422"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/tags?post=422"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}