Intérêt du fer intraveineux dans les anémies induites par l'hémodilution en chirurgie cardiaque pédiatrique

Abstract

Objective. – Anaemia is the main complication following haemodilution in paediatric cardiac surgery. Iron oral therapy is ineffective to improve anaemia. The aim of this study is to assess the effect of a single dose of intravenous iron saccharate Venofer ®. Study design. – Open, randomized. Patients and methods. – 93 patients were randomized in two groups. The first one is the control group without iron supplementation and the second one received a 5 mg/kg injection of Venofer ® administered at day 1. Three biological factors were studied on day 1 and day 5 following surgery: haemoglobin, ferrritin and reticulocyte rate. Student test was used for statistical analysis of results. Results. – Age, weight, haemoglobin, ferritine and reticulocyte on day 1 were similar in both group (no significant difference). On day 5 ferritin was higher in the treated group 215 ± 87 vs 101 ± 55 μg/l in the non treated group ( P < 0.001). Reticulocyte rate was also higher in the treated group 3.25 ± 1.16 vs 2.65 ± 0.97% ( P < 0.005) in the untreated group. Conclusion. – Postoperative systemic inflammation is probably the factor which impaired the effect of oral iron therapy. Parenteral iron may act by treating a functional iron deficiency and/or by increasing endogenous erythropoietin synthesis. Faster reversibility of anaemia following iron injection improves quality of the postoperative recovery.