Date Published: 
Friday, 19 September, 2014

Perioperative iron therapy shows promise in reducing the need for RBC transfusion in gastrointestinal surgery

Although perioperative intravenous iron may reduce use of red blood cell transfusion (RBCT), additional randomised controlled trials are required to confirm impact on patient outcomes, a comprehensive literature review has concluded.

Perioperative anaemia is a common and detrimental complication in surgical patients. RBCTs are often used to treat anaemia, but are associated with significant postoperative risks and worse patient outcomes compared with patients who are not transfused. Several studies have indicated that perioperative iron therapy may mitigate perioperative anaemia in patients undergoing gastrointestinal surgery. However, in many clinics, the use of iron therapy in this patient group is not considered routine practice.

The authors examined the impact of perioperative iron compared to no intervention on the need for RBCT in gastrointestinal surgery via a literature search of randomised controlled trials and non-randomised studies. Primary outcomes were proportion of patients receiving allogeneic RBCT and number of transfused patients. Secondary outcomes were haemoglobin change, 30-day postoperative morbidity and mortality, length of stay, and patient outcomes.

Meta-analysis revealed a trend toward fewer patients requiring RBCT with iron therapy (risk ratio, 0.66), but no benefit on the number of RBCT per patient (weighted mean difference, −0.91). One randomised controlled trial reported significantly increased post-intervention haemoglobin. Among three studies reporting length of stay, none observed a difference. Other secondary outcomes were not reported.

Although preliminary evidence indicates that perioperative iron therapy may be a promising strategy, the authors considered that studies are currently limited by heterogeneous interventions, small sample size, patient selection not based on anaemia status, and use of surrogate outcomes. Well-designed randomised controlled trials enrolling patients with pre-existing anaemia, focusing on the need for RBCT, and including long-term outcomes, are required.

The full article is available in Transfusion Medicine Reviews. For information on iron deficiency in gastroenterology, please click here.