Iron Therapy

Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is characterised by largely nocturnal, rest-induced, distressing urges to move the legs1.  Insomnia, interference with relationships and cramps are common, contributing to a decreased quality of life2,3. Iron deficiency is commonly associated with RLS2,3 and there are approximately three million patients in the USA alone with both conditions4. The role of intravenous iron as a primary therapy for iron deficient patients with RLS has become an area of major clinical research5

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).

Single-infusion ferric carboxymaltose improves symptoms of fatigue in iron deficient women with normal or borderline haemoglobin, new data reveal. The PREFER trial (Ferric Carboxymaltose Treatment to Improve Fatigue Symptoms in Iron-deficient Non-anaemic Women of Child Bearing Age) also demonstrates that ferric carboxymaltose may improve mental quality of life (QoL), cognitive function and erythropoiesis compared with placebo. Researchers suggest that ferric carboxymaltose may be an effective treatment alternative in patients who cannot tolerate or use oral iron.

Intravenous ferric carboxymaltose and a higher ferritin target may delay or reduce the need for additional anaemia treatment compared with oral iron in chronic kidney disease (CKD). In addition, a greater proportion of patients achieve a faster haematological response and haemoglobin increase, researchers reveal.

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.

New study data indicate that intravenous iron may improve health-related quality of life in women who have iron deficiency anaemia caused by abnormal uterine bleeding. In addition, treatment with ferumoxytol, where oral iron has previously been unsuccessful, increases haemoglobin levels in this patient group, according to the researchers.

Iron deficiency anaemia is associated with colorectal cancer1. Several studies have highlighted the important relationship between preoperative anaemia and poor postoperative outcomes for these patients1,2. One cause of this relationship may be increased perioperative allogeneic red blood cell transfusion (ARBT), as a result of preoperative anaemia. The use of ARBT has been independently linked with impaired surgical and oncological outcome3.

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