Efficacy Of Intravenous Iron Sucrose Research Articles

Utilidad de la administración de hierro sacarosa intravenoso para la corrección de la anemia preoperatoria en pacientes programados para cirugía mayor

There is a high incidence of perioperative anemia among surgical patients (20%-70%). Preoperative anemia has been linked to an increased postoperative morbidity and mortality, as well as a decreased quality of life of surgical patients. In addition, a low preoperative hemoglobin constitutes an important predictive factor of allogeneic blood transfusion in major surgery. We evaluated the efficacy of intravenous iron sucrose (IVIS) administration for correction of anemia in these patient populations.Data from 84 patients with anemia who were scheduled for major elective surgery (30 colon cancer resections, 33 abdominal hysterectomies, 21 lower limb arthroplasties) and who received preoperative IVIS during 3-5 weeks were propectively collected.Administration of IVIS -mean dose (standard deviation): 1000 (440)mg- caused a significant increase of hemoglobin levels -2.0 (1.6)g/dl (p<0.001)- and anemia was resolved in 58% of patients. No life-threatening adverse effect was witnessed.Because of the low incidence of side effects and the rapid increase of hemoglobin levels, IVIS emerges as a safe, effective drug for treating preoperative anemia in these patient populations.

Intravenous iron sucrose in maintenance dialysis patients with renal anemia: a clinical study

To explore the safety and efficacy of intravenous iron sucrose in maintenance dialysis and to establish the optimal administration frequency and dose. One hundred and ninety-four patients on maintenance dialysis with the hemoglobin (Hb) level of 60 - 100 g/L and hematocrit (Hct) of 18% - 30% were randomly divided into 2 sex, age, duration of dialysis, weekly erythropoietin dosage, and hematological parameters-matched groups: intravenous iron sucrose group (n = 102) and oral medication group (n = 92). The intravenous iron sucrose group were sub-divided into 2 subgroups: (1) hemodialysis (HD) subgroup receiving intravenous iron sucrose 200 mg once a week for 4 weeks and then 100 mg once a week for a further 8 weeks, and (2) peritoneal dialysis (PD) subgroup receiving intravenous iron sucrose 200 mg once a week for 4 weeks and then 200 mg once every other week for a further 8 weeks. The oral medication group received ferrous succinate 200 mg tid for 12 weeks. The levels of serum ferritin (SF), transferrin saturation (TSAT), Hb, and Hct were examined before treatment and 4, 8, and 12 weeks after treatment. (1) Compared with baseline levels, the levels of Hb, Hct, SF, and TSAT significantly increased 2 weeks after treatment in the intravenous iron sucrose group, and 4 weeks after treatment in the oral medication group (all P < 0.05). (2) The Hb, Hct, SF, and TSAT levels 4, 6, 8, and 12 weeks after treatment of the 2 intravenous iron sucrose subgroups were all significantly higher than those of the oral medication group (all P < 0.05). (3) The Hb, Hct, SF, and TSAT levels 12 weeks after treatment 6, 8, and 12 weeks after treatment were not significantly different from those 4 weeks after treatment in the intravenous iron sucrose group (all P > 0.05). (4) The response rate of the intravenous iron sucrose group was 95.09%, significantly higher than that of the oral medication group (55.44%, P < 0.05). (5) The mean EPO doses 6, 8 and 12 weeks after treatment of the intravenous iron sucrose group were significantly lower than that before treatment and those of the oral medication group (all P < 0.05). (6) The Hb, Hct, SF, and TSAT levels maintained stable during the period 6, 8, and 12 weeks after treatment in the intravenous iron sucrose group despite the decrease in dose and frequency. (7) The Hb, Hct, SF, and TSAT levels were significantly higher in the intravenous PD subgroup than in the intravenous HD subgroup. (8) No adverse event was found in the intravenous iron sucrose group, and adverse gastrointestinal effects occurred in 12 patients of the oral medication group. (9) After 12 weeks, the cost of EPO + intravenous iron sucrose was significantly higher than that of EPO + ferrous succinate. Intravenous iron sucrose effectively increases the serum iron parameters and hemoglobin levels during maintenance peritoneal dialysis and is well tolerated. Infusing intravenous iron sucrose 200 mg every two weeks can maintain the serum iron parameters and hemoglobin level in maintenance peritoneal dialysis patients and n permits reduction of the required dose of EPO. However, the total cost of intravenous iron treatment is relatively high.

Efficacy of Intravenous Iron Sucrose Administration for Correcting Preoperative Anemia in Patients Scheduled for Major Orthopedic Surgery

We thank Dr. Cuenca et al. for their comments on our article about the efficacy of intravenous iron sucrose in the treatment of preoperative anemia in patients undergoing major orthopedic surgery,1and are glad to answer their comments.We used the World Health Organization definition for anemia as inclusion criteria for our study and reviewed the literature concerning iron deficiency anemia. Interestingly, there is not one universally applicable definition for iron deficiency anemia. Recent papers by Thomas et al. 2–4indicate that the traditional definition for iron deficiency anemia with mean corpuscular volume &lt; 80 fl or a ferritin level &lt; 15–30 μg/l or transferrin saturation &lt; 15% does not take into account the effect of a possible inflammatory state. Therefore, we measured C-reactive protein as well as leukocyte count for every patient at the moment of inclusion. Leukocyte counts ranged from 4,300 to 9,500/μl (reference values being 4,000–10,000/μl in our laboratory) and C-reactive protein ranged from 0 to 12 mg/l (reference, &lt; 7 mg/l). By measuring the soluble transferrin receptor and calculating the ferritin index (soluble transferrin receptor/log ferritin ratio), and using different cutoff values depending on the measured C-reactive protein, we were able to select iron deficiency anemia.The theoretical total iron deficit for a target hemoglobin of 15 g/dl was calculated for every patient. Total iron deficit was 1,088 ± 239 mg, indicating that the administered dose of 900 mg was indeed slightly less than theoretically needed. Therefore, higher doses may be used in future studies. The perioperative blood loss was not considered in the calculation of the total iron dose, because only the preoperative hemoglobin increase was assessed.We compared the transfusion outcome of our group of patients with the study of Cuenca et al. 5and found astonishing similarities in both groups treated with intravenous iron. Comparing our results with a combined erythropoietin and intravenous iron treatment6or a treatment with oral iron7appears inadequate.8The question on repeated low dose intravenous iron was assessed in patients on hemodialysis.9Schiesser et al. 9showed that it is possible to maintain the iron status and the hemoglobin level with low dose intravenous iron. However, such a regimen did not allow improving the hemoglobin level. Nevertheless, in orthopedic surgery a direct comparison between repeated low dose versus high dose intravenous iron regimen may be the subject of a future study.In conclusion, intravenous iron should be considered for the relative rapid correction of iron deficiency anemia. However, the real benefit of such a regimen in the context of (orthopedic) surgery needs to be proven in a future prospective, randomized, placebo-controlled trial.*University Hospital and University of Zurich, Zurich, Switzerland. oliver.theusinger@usz.ch

Efficacy of Intravenous Iron Sucrose for Treating Anemia after Gastrectomy

목적: 위절제술을 시행받은 환자에게 있어서 빈혈은 흔하게 보고되고 있으며, 이들 중 일부는 빈혈의 교정이 필요하다. 본 연구의 목적은 빈혈의 치료로서 정맥용 철분제제인 Iron sucrose 사용의 유효성에 대하여 알아보고자 하였다. 대상 및 방법: 2007년 5월부터 2007년 10월까지 연세대학교 세브란스병원에서 위절제술을 시행받은 환자 중 외래추적관찰시 헤모글로빈 수치가 11 g/dl 이하인 47명의 환자들을 대상으로 하였다. Iron sucrose를 투여하기 전과 투여후 1주,2주,3주,3개월,6개월 뒤에 각각 혈색소(Hgb), 적혈구용적률(Hct), 혈청철(Serum iron), 총철결합능(TIBC), 혈청페리틴(Serum ferritin), 트란스페린(Transferrin)을 측정하여 효과를 전향적으로 비교 분석하였다. 결과: 47명의 환자 중 처방대로 치료를 받은 36명이 분석의 대상이 되었고 남자가 11명, 여자가 25명이었다. Hgb은 치료 전과 비교하여 치료 후 1주, 2주, 3주, 3개월, 6개월 후에는 0.6, 0.8, 1.3, 2.1, 2.2 g/dl 상승하여 통계적으로 유의한 변화를 보였다(각각 P 【Purpose: Many patients suffer with anemia after gastrectomy. Iron deficiency due to a decreased oral intake and malabsoption is the most common cause of anemia in gastrectomized patients. This study evaluated the efficacy of administering intravenous iron sucrose for treating patients with anemia. Materials and Methods: From May 2007 to October 2007 at Yonsei University Severance Hospital, we reviewed 47 outpatients whose hemoglobin levels were below 11 g/dl after gastrectomy. Iron sucrose was used for iron supplementation. To determine the difference between before and after the treatment (at 1 week, 2 weeks, 3 weeks, 3 months and 6 months after treatment), we prospectively examined such anemia parameters as the hemoglobin level (Hgb), the hematocrit (Hct), serum iron, TIBC, ferritin and transferin. Results: Out of the 47 patients, only 36 completed their treatment. Eleven were male and 25 were female. The Hgb levels, which indicate anemia, were elevated 0.6, 0.8, 1.3, 2.1 and 2.2 g/dl after 1 week, 2 weeks, 3 weeks, 3 months and 6 months after administration, respectively (P】