Considerations for Practice

This retrospective study, presented at the Annual Cardiovascular Critical Care conference in Washington 2013, showed that anaemia significantly impacts cardiac surgery outcomes. Correcting preoperative anaemia (inclusive of iron deficiency), where feasible, could potentially help to improve cardiac surgery outcomes and reduce costs.

Recommended tests for iron deficiency anaemia can be dramatically affected by factors such as infection and inflammation, a new article reports. Although more accurate tests are available, they are not currently widely utilised, indicating that a change in current diagnostic practice for patients with chronic kidney disease (CKD) may be necessary.

Intravenous ferric carboxymaltose is a suitable alternative to iron dextran for patients with iron deficiency anaemia, new data indicate. Ferric carboxymaltose showed similar efficacy (including change in haemoglogin) compared with iron dextran, with fewer allergic reactions and a greater effect on the restoration of iron (ferritin) stores.

Data supporting the need for better recognition of iron deficiency will be presented this week at the United European Gastroenterology Week Congress in Berlin1. Iron deficiency is frequently under-diagnosed resulting in increased hospitalisation, reduced quality of life and higher death rates in patients with comorbid conditions2–9. The WHO has estimated that iron deficiency causes the loss of 48,225 disability-adjusted life-years (DALYs) worldwide, more than is seen with lung cancer2.

Decreased absorption of oral iron leading to iron deficiency is a significant cause of anaemia in patients with gastrointestinal conditions including inflammatory bowel disease (IBD) and following gastric bypass surgery. Although oral iron is often used, reductions in intestinal absorption mean that the effectiveness of such treatment may be limited in these patients. Intravenous iron has been shown to be a safe, effective treatment strategy for overcoming the iron deficiency associated with these conditions, resulting in better outcomes and improved quality of life.

In this interesting randomised multicentre open-label trial, the authors explore the traditional and well-known intravenous iron complex, iron sucrose, administered as multiple infusions over two weeks versus ferric carboxymaltose, which can be administered in only two applications over one week, in a large group of patients with iron deficiency anaemia and non-dialysis dependent chronic kidney disease (NDD-CKD). They conclude that although both regimens are similar regarding primary composite safety endpoints, ferric carboxymaltose is more effective and may reduce healthcare costs.


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