Considerations for Practice

Patients scheduled for major elective orthopaedic procedures frequently present with preoperative iron deficiency and anaemia1,2. Iron deficiency anaemia is the most common form of anaemia and preoperative anaemia has been linked to higher postoperative infection rate, poorer physical functioning and recovery, decreased quality of life, and increased length of hospital stay (LOS) and mortality1–5.

The recent article by Viethen and colleagues examines the potential role of intravenous iron in a clinical scenario that has not been widely studied, but which has previously yielded some positive data. It builds on a previous publication by Smith and colleagues1 that intravenous iron may be of potential benefit in pulmonary arterial hypertension (PAH).

Study results have revealed that treatment with i.v. ferric carboxymaltose is associated with a more frequent correction of post-operative anaemia than oral treatment with ferrous glycine sulphate.

Post-operative anaemia is common in patients undergoing major orthopaedic surgery such as total knee arthroplasty (TKA). The prolonged low Hb levels following major surgery has been associated with increased mortality and morbidity.

A new study suggests that iron therapy can be given to iron-deficient rats undergoing anthracycline-based chemotherapy without increasing anthracycline-induced cardiotoxicity (AIC). The authors suggest that oxidative and nitrosative stress, inflammation, and cardiotoxicity, may be reduced by iron therapy treatment in this animal group.

A new study presented at the Digestive Diseases Week (3–6 May 2014, Chicago, USA) has shown that the intravenous iron therapy, ferric carboxymaltose, improves symptoms of iron deficiency anaemia, and has an improved safety profile compared with other intravenous iron treatments currently available.

Iron deficiency is an important pathogenic factor affecting the severity and progression of chronic heart failure. Until now, iron deficiency diagnosis was based on the assessment of transferrin saturation and serum ferritin. Unfortunately, these standard measures of iron status are unreliable in the acute clinical settings (such as in acute heart failure)1.

A new article has indicated that both iron deficiency and anaemia are prevalent in patients with Crohn’s disease and ulcerative colitis, with a higher prevalence in the former. The authors also demonstrate that more than half of anaemic patients with inflammatory bowel disease have iron deficiency.

The prevalence of iron deficiency in female, but not male, blood donors increases with donation frequency and decreases with age, new data indicate. The authors suggest that these results should inform blood organisations seeking to alleviate the burden of iron deficiency.

Iron deficiency is an important consequence of blood donation. This cross sectional study of Australian blood donors investigated the problem in the blood donor population to enable identification of potential solutions to donor iron deficiency.

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