Abstract
Despite the reported benefits of intravenous iron therapy (IVIT) for correcting iron deficiency anemia (IDA) before any major surgery and the evidence thereof, perioperative allogenic blood transfusion (ABT) practice is still considered as the only viable option by some clinicians worldwide. As ABT increases the likelihood of infections, cardiac complications, longer hospital stays and mortality among the patients, the practice of ABT should only be reserved for critical cases (Hb level < 7 g/dl). Timely iron studies and iron replenishment (oral/IV) of prospective surgical patients could help decrease the ABT practice, and prove beneficial from both the clinical and economic standpoint. Evidence based patient blood management guidelines should be developed and standardized for use by clinicians worldwide. These guidelines should include specific instructions on timely assessment of surgical patients for correction of their IDA by either oral iron supplementation, if time permits, or by using IVIT such as ferric carboxymaltose (FCM) in emergency surgeries and in patients with functional ID. This study was conducted to explore the clinical benefits of the timely administration of IV-FCM in iron-deficient preoperative patients during 2017–2018 and compare the results thereof with that of the ABT. Based on the IDA treatment plan of 2953 patients, 11.14% cases were administered IV FCM (Group 1), 11.58% cases received ABT (Group 2), while the remaining 77.27% of anemic cases received neither ABT nor IV FCM (Group 3). The results indicate that the IV FCM administration reduces the need for ABT and thus minimizes its associated side effects. The findings of our study concur with the favorable outcomes reported by the other similar studies.
Highlights
Despite the reported benefits of intravenous iron therapy (IVIT) for correcting iron deficiency anemia (IDA) before any major surgery and the evidence thereof, perioperative allogenic blood transfusion (ABT) practice is still considered as the only viable option by some clinicians worldwide
We explored the presence of hypophosphatemia that may have occurred as a side effect of IV ferric carboxymaltose (FCM) administration
The data analyses of the surgical records of 10,571 patients (5370 from 2017 and 5201 from 2018) who underwent surgery yielded the following results: 2953 of the 10,571 (27.93%) cases had anemia (Hb < 12.0 g/dl for women and Hb < 13.0 g/dl for men) (Fig. 1), out of which 879 (29.76%) patients had IDA. 329 of the 2953 (11.14%) cases were administered IV FCM and were classified as Group 1 (Fig. 2), 342 of the Scientific Reports | (2020) 10:18403 |
Summary
Despite the reported benefits of intravenous iron therapy (IVIT) for correcting iron deficiency anemia (IDA) before any major surgery and the evidence thereof, perioperative allogenic blood transfusion (ABT) practice is still considered as the only viable option by some clinicians worldwide. Evidence based patient blood management guidelines should be developed and standardized for use by clinicians worldwide These guidelines should include specific instructions on timely assessment of surgical patients for correction of their IDA by either oral iron supplementation, if time permits, or by using IVIT such as ferric carboxymaltose (FCM) in emergency surgeries and in patients with functional ID. Regardless of whether the ID or iron deficiency anemia (IDA) develops due to a disease process and or therapy, it is a cause of concern in patients who undergo surgery because it adversely impacts the prognosis[14]. The mounting evidence supporting the predicted positive effect of IV iron on iron levels in the immediate postoperative period and subsequent weeks after hospital discharge would encourage the widespread use of IV iron (e.g. FCM) in preoperative IDA patients
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