Surgery

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.

A recent study by Munoz and colleagues demonstrated that transfusion rates in patients with hip fracture were lower in those who received intravenous iron compared with those who received no iron therapy (32.4 vs 48.8%, respectively; n=2547). Postoperative nosocomial infection rates were lower in patients who received intravenous iron, as was thirty-day mortality and length of hospital stay1.

20Jeong et al recently reported the results of a retrospective observational study of 527 patients undergoing gastrectomy for gastric carcinoma. Patients with acute postoperative anaemia (haemoglobin <10 g/dL) received intravenous iron sucrose. Patients with preexisting, preoperative anaemia were excluded. A dose of 300 mg was administered every other day until reaching the total target amount, calculated as:

(body weight x [target haemoglobin – current haemoglobin] x 0.24) + 500 mg

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.

Ferric carboxymaltose has the same or better efficacy as standard preparations for parenteral iron replacement in patients who have undergone bariatric and gastric surgery, new data indicates. The simple dosing requirements of ferric carboxymaltose make the preparation an attractive option for this patient population, as attendance at follow-up appointments is traditionally poor.

Intravenous iron replacement therapy appears to reduce platelet count in patients with secondary thrombocytosis, results of a small clinical trial suggest. This indicates a link with iron deficiency and could inform the management of a range of conditions with increased thromboembolic risk, including inflammatory bowel disease, cancer, orthopaedic surgery and chronic disease.

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