Optimizing preoperative haemoglobin in major orthopaedic surgery using intravenous iron with or without erythropoietin. An epidemiologic study

Rev Esp Anestesiol Reanim. 2015 Jun-Jul;62(6):313-21. doi: 10.1016/j.redar.2014.07.011. Epub 2015 Feb 17.
[Article in English, Spanish]

Abstract

Aim: To evaluate the effectiveness of intravenous iron treatment, with or without associated erythropoietin (rHuEPO), measured as haemoglobin (Hb) increase. The relationships between the Hb increase and parameters used to evaluate anaemia were analysed.

Material and method: Retrospective observational study carried out in two third-level hospitals between January 2005 and December 2009. The study included patients with iron deficiency anaemia scheduled for elective orthopaedic surgery and treated with intravenous iron sucrose alone or associated with rHuEPO. Treatment efficacy was analysed based on the Hb increase from baseline to just before surgery.

Results: A total of 412 patients who received a median of 800mg of iron sucrose were included; 125 of them (30.4%) additionally received 2.4 vials of rHuEPO. The Hb increase was 0.8 (1.1) g/dL in patients treated with intravenous iron and 1.5 (1.3) g/dL in those additionally given rHuEPO(P<.01). The percentage of hypochromic red blood cells (r=0.52) and soluble transferrin receptor (r=0.59) value were significantly correlated to the Hb increase in patients receiving iron.

Conclusions: In patients with iron deficiency anaemia, the effectiveness of iron sucrose treatment to optimize Hb before surgery was moderate; adjuvant administration of erythropoietin improved the results. Determination of functional iron status parameters may improve the treatment effectiveness.

Keywords: Anaemia; Anemia ferropénica; Deficiencia de hierro; Eritropoyetina; Erythrocyte indices; Erythropoietin; Iron-deficiency; Orthopaedic procedures; Ortopedia; Período preoperatorio; Preoperative period; Receptores; Receptors; Transferrin; Transferrina; Índices eritrocitarios.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anemia, Iron-Deficiency / blood*
  • Anemia, Iron-Deficiency / drug therapy*
  • Epidemiologic Studies
  • Erythropoietin / administration & dosage*
  • Female
  • Ferric Compounds / administration & dosage*
  • Ferric Oxide, Saccharated
  • Glucaric Acid / administration & dosage*
  • Hematinics / administration & dosage*
  • Hemoglobins / analysis*
  • Humans
  • Injections, Intravenous
  • Male
  • Orthopedic Procedures*
  • Preoperative Care*
  • Retrospective Studies

Substances

  • Ferric Compounds
  • Hematinics
  • Hemoglobins
  • Erythropoietin
  • Ferric Oxide, Saccharated
  • Glucaric Acid