Blood management guidelines should be updated to include postoperative iron replacement in surgical patients with anaemia, according to an Australian study published in The Lancet Haematology.
Lead researcher Professor Alhossain Khalafallah, from the department of haematology and medicine at Launceston General Hospital, said the intervention was safe, effective and more practical than the current focus on boosting iron preoperatively.
“Ideally, we’d like preoperative optimisation of iron stores for all our patients but that requires coordination and time before surgery that we don’t always have.”
“In the postoperative setting, the patient is already in hospital with a cannulae in place so no extra visits or resources are required.
We have their postop blood tests and we know their iron or haemoglobin is low so we’re also concentrating on the patients who will benefit most,” he said.
The prospective open label study compared haemoglobin, iron stores and clinical outcomes in 201 patients undergoing elective surgery including orthopaedic, abdominal, gynecological and urological procedures.
Inclusion criteria were low haemoglobin (70-120g/L), suboptimal serum ferritin (<100ug/L) or low iron saturation (<20%). Patients were randomised to either a single dose of 800-1000mg IV ferric carboxymaltose on the day after surgery or standard care of observation.
At four weeks postop, haemoglobin and iron status had significantly improved in the treated group compared to the control group. The improvements remained significant at 12 weeks for iron status but not for haemoglobin.
“Importantly, intravenous iron reduced the number of blood transfusions from 6% to 1%, length of hospital stay by three days and complications such as post operative infection from 14% to 2%,” Prof Khalafallah said.
“We’re improving patient outcomes with minimal invasiveness and minimal cost,” he said.
“And while the cost benefit analysis has yet to be done, there is huge potential to save money by fewer days in hospital, fewer investigations and fewer interventions such as transfusions or antibiotics.”
In a commentary on the research, international colleagues from Europe and the US supported the call for updating guidelines on patient blood management.
“We… hope that surgeons move forward in adding this safe, effective, and convenient therapy to the current treatment algorithm for postoperative anaemia,” they said.