Abstract
BackgroundUnnecessary costs and complications can be reduced by increasing hemoglobin (Hb) levels and minimizing blood transfusions in patients who underwent total knee arthroplasty (TKA). This study aimed to determine the effects of intravenous iron monotherapy before TKA on preoperative iron deficient anemia and postoperative transfusion rates.MethodsThis prospective cohort study included 45 patients scheduled for TKA in the experimental group (Group I) and 221 patients who underwent TKA in 2015 and 2018 in the control group (Group C). One thousand milligrams of ferric carboxymaltose was administrated 1 month before TKA in group I. Intergroup comparison of the rate and total volume of transfusion, perioperative changes in Hb and analysis of iron metabolism variables in group I were performed. Subgroup analysis of Group I was conducted according to the response to iron monotherapy.ResultsAlthough Hb levels increased after intravenous iron monotherapy in Group I, postoperative transfusion rates in Groups I and C were 17.8% and 18.6%, respectively, without significant intergroup differences in the rate and total units of transfusion. Ferritin level and transferrin saturation were corrected in both subgroups of Group I. Only 17 patients (37.78%) showed response to iron monotherapy, with an Hb increase of 1.0 g/dL or more. Subgroup analysis showed lower proportions of coexisting chronic diseases, including chronic kidney disease in responders.ConclusionIV iron monotherapy was shown to be insufficient in successfully treating preoperative iron-deficient anemia to reduce postoperative allogenic blood transfusion in patients who underwent TKA. As preoperative anemia should be managed due to the high rates of postoperative transfusion for this surgery, clinicians should consider the complex interplay among the causal factors of anemia, apart from ID, in patients with preoperative anemia who are scheduled for TKA.
Highlights
Unnecessary costs and complications can be reduced by increasing hemoglobin (Hb) levels and minimizing blood transfusions in patients who underwent total knee arthroplasty (TKA)
This study revealed that IV iron monotherapy before TKA did not affect the rate or total units of transfusion in patients with preoperative anemia
Considering that preoperative anemia is an indicator for postoperative blood transfusions, clinicians should increase patients’ Hb levels to minimize blood transfusions associated with TKA [4]
Summary
Unnecessary costs and complications can be reduced by increasing hemoglobin (Hb) levels and minimizing blood transfusions in patients who underwent total knee arthroplasty (TKA). This study aimed to determine the effects of intravenous iron monotherapy before TKA on preoperative iron deficient anemia and postoperative transfusion rates. Several blood management strategies, such as erythropoietin administration and (2020) 2:22 intravenous (IV) or oral iron supplementation, have been used to achieve optimal preoperative Hb levels and reduce the requirement of postoperative transfusion [7, 8]. The effects and role of IV iron monotherapy in patients with preoperative iron deficient anemia who undergo TKA remain unclear. We hypothesized that IV iron monotherapy would normalize Hb levels and reduce transfusion rates in patients with preoperative iron deficient anemia scheduled to undergo TKA. This study aimed to determine the effectiveness of IV iron monotherapy in a clinical setting
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