Iron Administration Research Articles

Iron supplementation protects against renal ischemia-reperfusion injury by enhancing mitochondrial respiratory complex assembly.

Abstract Background and Aims Iron deficiency is an anemia-independent mortality risk in people with chronic kidney disease who do not require dialysis. Less is known regarding this association in dialysis dependent kidney failure, particularly in peritoneal dialysis (PD). Transferrin saturation (TSAT) and ferritin are commonly assessed in dialysis care to evaluate iron stores. This study investigated the risk of death in incident peritoneal dialysis patients based on iron stores and IV iron therapy. Method We evaluated data from incident adult PD patients treated between 2004 and 2011 at a large US dialysis provider network. Patients were included if they were on PD for ≥180 days, had no modality change for ≥90 days, and had at least one measurement of TSAT, ferritin, hemoglobin, and albumin during the 180-day baseline period after initiation of PD. Adjusted Cox proportional hazards model with smoothing splines were used to investigate the hazard ratio for death across continuous values of TSAT and ferritin. Analyses were assessed by IV iron administration status during the baseline period. Adjustments were made for demographic characteristics (age, sex, race, dialysis vintage, and history of hemodialysis before PD start), comorbidities (gastrointestinal bleeding, peripheral vascular disease, hypertension, cardiovascular disease, cerebrovascular disease, heart failure, acute myocardial infarction, diabetes mellitus and cancer), laboratory values (albumin, hemoglobin, white blood cell (WBC) counts), and erythropoiesis-stimulating agent (ESA) usage. Results Out of the final cohort of 11,013 patients (mean age of 55 years, 54% male, 70% Caucasian, albumin of 3.6 g/dL, TSAT of 31%, and ferritin of 445 ng/dL), 34% received IV iron therapy during the 180-day baseline period after starting PD. Majority (90.5%) of the cohort received an ESA dose during baseline. Patients with TSAT levels <25% were observed to have higher risks of death as compared to higher levels (Fig. 1). This pattern was consistent in the subgroup of patients who did not receive IV iron and was independent of hemoglobin levels. Despite this, the impact of low TSAT on mortality was attenuated in patients who received IV iron. High ferritin was associated with increased risk of death among those who did not receive any IV iron, yet the risk of death was not present in those who received IV iron. Conclusion Our analysis revealed that iron deficiency is associated with mortality risk among patients starting PD treatment. This effect was independent from hemoglobin and restricted to those not treated with IV iron. High ferritin levels were associated with an increased mortality risk in those who did not receive IV iron; there was no association between ferritin and mortality risk in patients who received IV iron. These findings suggest a duality in how ferritin can be an indicator of functional iron deficiency and inflammatory-driven mortality risk, which could have potential implications for managing iron therapy in PD patients.

506 Background: Anemia is a common and often multifactorial complication of chemotherapy and immunotherapy, contributing to increased morbidity and decreased quality of life in cancer patients. The National Comprehensive Cancer Network (NCCN) provides clear guidelines for evaluating and managing cancer-induced anemia (CIA), yet adherence, especially in community oncology settings, remains inconsistent. A community cancer center’s internal review revealed delays in appropriate anemia management, primarily due to inadequate screening for the etiology of anemia. Methods: A quality improvement initiative was implemented to increase the rate of anemia panel testing among patients receiving chemotherapy or immunotherapy (excluding breast cancer) with hemoglobin levels <10 g/dL. The goal was to increase panel ordering from a baseline of 49% to 70% over six months (November 1, 2024, to May 1, 2025). A standardized anemia evaluation workflow tool was introduced for use by clinical staff (RN, LVN, NP, MD) to guide decision-making regarding anemia panel testing and subsequent treatment. A total of 1,387 charts were reviewed during the study period, with 119 patients meeting inclusion criteria. Results: Among the 119 eligible patients identified, anemia panels were ordered in 98 cases (80%), surpassing the target goal of 70%. This reflects a 31% relative improvement from baseline. Implementing the workflow tool supported more consistent and timely identification of anemia etiology, leading to earlier and more appropriate interventions such as iron infusions and administration of erythropoiesis-stimulating agents. Conclusions: This quality improvement initiative significantly increased adherence to evidence-based guidelines for evaluating CIA. The standardized workflow facilitated provider compliance with NCCN recommendations and payer requirements, enhancing clinical decision-making and improving the timeliness and quality of anemia management in a community oncology setting. These results underscore the value of systematic process interventions in enhancing care delivery and patient outcomes in cancer care.

Citrate, a green alternative to heparin.

Anemia among expectant mothers is a major health issue worldwide, especially in developing countries, where prevalence reaches 37%. Various interventions, such as micronutrient supplementation and intravenous iron administration, have been widely implemented. However, limited systematic reviews have comprehensively evaluated both the cost-effectiveness and feasibility of such interventions in low- and middle-income countries (LMICs). This study aims to systematically evaluate recent evidence on the feasibility and cost-effectiveness of anemia management interventions for pregnant women in developing countries. The review followed the 2020 PRISMA guidelines and was registered in PROSPERO (CRD420251089753). Article searches were conducted across five primary databases (CINAHL, CENTRAL, PubMed, Wiley, and Taylor & Francis) for publications between 2015 and 2025. Study selection was performed independently by six authors. Seven studies meeting the inclusion criteria were analyzed narratively. The findings indicated that interventions such as Multiple Micronutrient Supplementation (MMS) and Intravenous Iron Sucrose (IVIS) were highly cost-effective, demonstrating Incremental Cost-Effectiveness Ratios (ICERs) substantially lower than the willingness-to-pay threshold (USD 653–1,792 per DALY) in developing nations, including Indonesia. Feasibility of implementation was influenced by healthcare system capacity, logistical resources, educational initiatives, and sociocultural contexts. Overall, MMS and IVIS interventions demonstrated superior efficiency and effectiveness compared to conventional therapies, though their success relies on system readiness and contextual adaptation. This review fills a critical evidence gap by jointly assessing cost-effectiveness and real-world feasibility, providing a strong foundation for designing sustainable, evidence-based strategies to manage anemia in resource-limited settings.

Correction of iron deficiency anemia in liver transplantation. Preliminary study.

Cold agglutinin disease (CAD) is arare but clinically impressive disease with a high level of disease burden and arisk of severe thromboembolic complications. This review article provides aconcise, clinically oriented summary of the current knowledge on the disease and the treatment options. The diagnosis requires the detection of achronic hemolysis with demonstration of C3d in amonospecific direct Coombs or antiglobulin test (DAT), the detection of cold agglutinins with atiter ≥ 1:64 at 4 °C and the exclusion of amalignant disease or relevant infection. Treatment options are so far the avoidance of low temperatures, adequate hydration in hemolytic crises, thrombosis prophylaxis as well as immunosuppressive treatment with rituximab and/or cytostatic agents. The only approved treatment iscomplement inhibition with sutimlimab. The hemolysis responds to inhibition of the classical complement pathway with the anti-C1s antibody sutimlimab within afew days with adecrease of hemolysis parameters and an improvement of fatigue. The treatment requires a comprehensive vaccination against capsulated bacteria and if necessary, abridging antibiotic prophylaxis until this has been achieved. Supplementary treatment, such as administration of folic acid, vitamin B12 and iron in cases of deficiency or also acombination with other treatment strategies should be considered when necessary. Data on the use of sutimlimab in secondary cold agglutinin syndrome (CAS) are not yet available. Knowledge of the specific clinical and laboratory hallmark changes of CAD with the early initiation of specific and targeted therapy or also referral to specialized centers has significantly improved the prognosis of the disease in recent years and reduced the suffering of patients.

Facioscapulohumeral muscular dystrophy (FSHD) is a genetic muscle disease caused by ectopic expression of the toxic protein DUX4, resulting in muscle weakness. However, the mechanism by which DUX4 exerts its toxicity remains unclear. In this study, we observed abnormal iron accumulation in muscles of patients with FSHD and in mice with muscle-specific DUX4 expression (DUX4-Tg mice). Treatment with iron chelators, an iron-deficient diet, and genetic modifications inhibiting intracellular uptake of iron did not improve but rather exacerbated FSHD pathology in DUX4-Tg mice. Unexpectedly, however, iron supplementation, from either a high-iron diet or intravenous iron administration, resulted in remarkable improvement in grip strength and running performance in DUX4-Tg mice. Iron supplementation suppressed abnormal iron accumulation and the ferroptosis-related pathway involving increased lipid peroxidation in DUX4-Tg muscle. Muscle-specific DUX4 expression led to retinal vasculopathy, a part of FSHD pathology, which was prevented by iron administration. Furthermore, high-throughput compound screening of the ferroptosis pathway identified drug candidates including ferrostatin-1 (Fer-1), a potent inhibitor of lipid peroxidation. Treatment with Fer-1 dramatically improved physical function in DUX4-Tg mice. Our findings demonstrate that DUX4-provoked toxicity is involved in the activation of the ferroptosis-related pathway and that supplementary iron could be a promising and readily available therapeutic option for FSHD.

Introduction Implant-associated infection (IAI) caused by gram-negative pathogens is characterized by a more severe, recurrent course and higher mortality than the one caused by gram-positive ones. The main reason is growing antibiotic resistance of these pathogens and the complexity of choosing drugs for inpatient and outpatient therapy.Purpose To evaluate the influence of various factors and compare the features of the course of implant-associated infection caused by P. aeruginosa, K. pneumoniae, A. baumannii in patients with positive and poor treatment outcomesMethods A retrospective analysis of the medical records of 172 patients treated at the Department of Purulent Osteology between January 1, 2017 and December 31, 2022 for implant-associated infection caused by P. aeruginosa, K. pneumoniae, A. baumannii was conducted. Based on the results of a telephone survey or examination, patients were divided into 2 groups: positive and poor treatment outcomes by Delphi criteria. The impact of various factors in the anamnesis, laboratory and microbiological analysis, features of surgical intervention, antibacterial therapy and the course of the early postoperative period on the outcomes was analyzed in the IBM SPSS STATISTICS (version 26).Results Among patients with IAI caused by gram-negative bacteria, the rate of poor outcomes was 45 %, with fatality rate of 10 %. During the comparative study, a statistically significant effect on the development of a poor outcome was shown by the postoperative level of serum albumin (p = 0.002), the sensitivity of the isolated isolate to the tested antibacterial drugs (p = 0.011), the isolation of the pathogen from patients’ biomaterial in the postoperative period (p = 0.001), a more frequent need for intravenous administration of albumin and iron (p = 0.003 and p = 0.056, respectively) and the need for repeated surgical intervention in the early postoperative period (p = 0.001).Discussion IAI caused by gram-negative bacteria is characterized by a prolonged recurrent course and high mortality, primarily associated with the overall growing antibiotic resistance of pathogens which requires an individual approach to both surgical treatment and drug therapy, as well as the development of new tactical approaches to therapy.Conclusion The rate of poor outcomes was 45 %. Hypoalbuminemia and antibacterial resistance of isolates of P. aeruginosa, K. pneumoniae, A. baumannii, detection of the pathogens in the postoperative material, as well as the need for surgical reoperation in the early postoperative period, are risk factors for poor outcomes.

Background: Iron deficiency anemia is common in pregnancy and is of great concern with regards to maternal health as well as increasing the risk of complication such as primary postpartum hemorrhage. Parenteral iron administration is one option that has become available for anemia but its role in preventing postpartum hemorrhage in pregnant women with mild to moderate anemia is an area that is in need of further investigation. Objective: To determine the efficacy of parenteral iron in prevention of primary postpartum hemorrhage in mild to moderate anemic patients. Study Design: Quasi-experimental study. Duration and Place of Study: The study was conducted between August 2024 and February 2025 at the Department of Obstetrics and Gynaecology, Saidu Group of Teaching Hospitals, Swat. Methodology: A total of 139 women with singleton pregnancy in the 18–40 years range with anemia with an Hb of 8-12 g/dL were included in the recruitment. The subjects received intravenous iron sucrose 600 mg that was given in three consecutive days starting from 28 weeks' gestational age. The absence of immediate postpartum hemorrhage in the form of blood loss of ≥1000 ml with cesarean section or ≥500 ml with vaginal delivery was the primary outcome. Results: The subjects' mean age was 29.30 ± 4.42 years while the level of hemoglobin was 9.13 ± 1.02 g/dL upon enrollment. The parenteral iron therapy had an efficacy of 92.8% with no correlations of significance between demographic variables like age, BMI, or mode of delivery with efficacy. Of interest was that there was an inverse correlation of significance between hemoglobin level and efficacy such that those with the lowest baseline hemoglobin levels had the best response to the therapy. Conclusion: Parenteral iron sucrose is an effective and well-tolerated treatment for preventing primary postpartum hemorrhage in anemic pregnant women, with high efficacy across various demographic groups.

Background: Iron is an important micronutrient under physiological conditions, including pregnancy. On the other hand, excessive iron intake is also associated with adverse pregnancy outcomes. Macrophages are crucial in regulating iron homeostasis and pregnancy conditions. However, the role of macrophages in iron metabolism during pregnancy is unclear. Therefore, we used mouse models to investigate whether maternal iron overload induces pregnancy complications and their interactions with macrophages. Methods and Results: Administration of high-dose iron (iron dextran) by intraperitoneal injection to pregnant mice induced pregnancy complications such as fetal death, but low-dose iron did not affect fetal weight. In the placenta, the amount of iron was significantly increased and levels of macrophages were decreased by iron administration. In the liver, iron administration dramatically increased the amount of iron, with increased inflammatory cytokines tumor necrosis factor-α (TNFα) and interleukin-6. Macrophages were observed to surround deposited iron in the liver. In an in vitro experiment, treatment with iron stimulated TNFα secretion with cell death in macrophages, but not in liver cells. To investigate the importance of macrophages during pregnancy, clodronate liposomes were administered to reduce macrophages in pregnant mice. The macrophage reduction in pregnant mice resulted in an increased absorption rate and fetal growth restriction, together with higher iron accumulation and inflammatory cytokines in the liver. Conclusions: Maternal excess iron may induce inflammatory conditions with macrophage dysfunction in the liver, resulting in pregnancy complications. The reduction in macrophages also induced higher iron levels and adverse effects during pregnancy, suggesting a vicious cycle between excessive iron and macrophage dysfunction during pregnancy.

Intravenous iron for iron deficiency in heart failure with preserved ejection fraction. A multivariate analysis

Previous studies suggest that administration of erythropoiesis-stimulating agents darbepoetin or erythropoietin to preterm infants results in fewer transfusions, fewer donor exposures, and improved neurodevelopmental outcome. To determine if, compared with placebo, preterm infants randomized to weekly darbepoetin would have greater red cell mass during hospitalization and better neurocognitive outcome at 22 to 26 months' corrected age. This randomized clinical trial was conducted between September 2017 and November 2019 for infants 23 0/7 to 28 6/7 weeks' gestation in 19 US Neonatal Research Network centers comprising 33 neonatal intensive care units. Follow-up occurred through January 2023. Infants were randomized by 36 hours after birth to weekly placebo or darbepoetin (10 μg/kg) through 35 weeks' postmenstrual age. Iron administration and transfusions were administered by protocol. Study data were analyzed from June to October 2023. The primary outcome was the mean cognitive composite score on the Bayley Scales of Infant Development, third edition (Bayley-III) at 22 to 26 months' corrected age. The lowest possible score (54) was assigned to infants who died. A total of 650 infants (322 darbepoetin; 328 placebo; mean [SD] gestational age, 26.2 [1.7] weeks; 328 female [50.5%]) were enrolled. Five hundred eighty-three infants (291 darbepoetin; 292 placebo) had the primary outcome determined (90% of those enrolled). Mean (SD) cognitive scores were similar between groups: 80.7 (19.5) darbepoetin vs 80.1 (18.7) placebo, adjusted mean difference, -0.23 (95% CI, -3.09 to 2.64). Compared with infants receiving placebo, more infants in the darbepoetin group were transfusion free (40% [127 of 319] vs 21% [70 of 327]; adjusted relative risk [RR], 1.3; 95% CI, 1.2-1.5), received fewer transfusions (mean [SD], 2.3 [3.1] vs 3.3 [3.5]), were exposed to fewer donors (mean [SD], 1.6 [2.3] vs 2.2 [2.3]), had higher red cell mass by week 2 of age (adjusted mean difference, 3.2; 95% CI, 1.7-4.7), and higher mean hematocrit by week 2 of age (adjusted mean difference, 2.8; 95% CI, 2.1-3.6), and were less likely to have bronchopulmonary dysplasia greater than grade 1 (35% [91 of 261] vs 46% [128 of 277]; RR, 0.78; 95% CI, 0.64-0.96). The incidence of retinopathy of prematurity stage greater than 2 was similar between groups, 13% (35 of 273) in the darbepoetin group vs 16% (45 of 279) in the placebo group. There were no differences in adverse effects between groups. Results of this randomized clinical trial reveal that this dose and dosing schedule of darbepoetin did not improve cognitive scores of preterm infants at 22 to 26 months' corrected age. Darbepoetin significantly increased red cell mass resulting in higher hematocrit values, fewer transfusions, and fewer donor exposures. ClinicalTrials.gov Identifier: NCT03169881.

Optimiser la prise en charge de la carence martiale dans l’IC grâce à l’HAD

Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract. It includes Crohn's disease (CD) and ulcerative colitis (UC). It occurs with periods of exacerbations and remissions. One of the most common complications of IBD is iron deficiency anemia (IDA). In IBD, iron deficiency anemia (IDA) often occurs concomitantly with anemia of chronic disease, caused by chronic inflammation of the gastrointestinal tract. Disturbance of iron homeostasis in IBD results from inflammation of the intestinal mucosa, which causes increased blood loss from the gastrointestinal tract and poor iron absorption. A key role is played by hepcidin, which, by acting on ferroportin, inhibits iron absorption in the intestines, despite its deficiency. Less common causes of anemia in IBD include vitamin B12 deficiency, folate deficiency, hemolysis, drug-induced aplasia, or liver disease such as primary sclerosing cholangitis. Symptoms of iron deficiency depend on the severity and chronicity of the anemia. Anemia reduces the quality of life of patients, so diagnosis and treatment of iron deficiency anemia in IBD is essential. Regular monitoring of anemia and iron homeostasis is recommended. Tests should be performed at the time of IBD diagnosis, every 3 months in active disease and every 6-12 months in periods of remission. In all patients with IBD, it is necessary to follow an appropriate diet, but also to treat anemia with iron preparations, oral or intravenous. The choice of the method of iron administration, oral or intravenous, depends on the hemoglobin level, IBD activity, and the patient's tolerance to oral preparations. Regular monitoring is essential because anemia in IBD often recurs.

IntroductionPreoperative anemia is an important target in preventing colorectal anastomotic leakage (CAL). However, it is not consistently detected and corrected in patients undergoing colorectal surgery. This study aimed to evaluate the impact of early detection and correction of preoperative anemia on perioperative outcomes and CAL.MethodsThis was a prospective subanalysis of an international open-labeled trial, which implemented an enhanced care bundle to prevent CAL after elective colorectal surgeries. It introduced interventions for early detection and correction of preoperative anemia. Primary outcome was the incidence of preoperative anemia and the effect of early correction. Secondary outcomes included the impact on CAL, postoperative course, and mortality.ResultsThe study included 899 patients across eight European hospitals (September 2021–December 2023). Preoperative anemia was identified in 35.0% (n = 315) of participants, with 77.4% (n = 192) receiving iron therapy. Hemoglobin levels decreased in 4.2% (n = 13), remained stable in 45.8% (n = 143), and increased in 50.0% (n = 156) (p < 0.001). Perioperative hyperglycemia was more common among patients with anemia (7.8% versus 16.4%, p < 0.001). CAL occurred in 6.1% (n = 53) of patients. Anemia correction and changes in hemoglobin levels after iron treatment were not significantly associated with CAL, other complications, or mortality.ConclusionsEarly detection and correction of preoperative anemia is achievable. However, routine preoperative administration of iron alone, without concurrently optimizing other CAL risk factors, does not result in CAL prevention. Preoperative anemia indicates overall poor physiological fitness rather than being an isolated risk factor.Trial numberNCT05250882 (20-01-2022).

BackgroundWe aimed to investigate the effect of preoperative intravenous (IV) iron administration on maternal outcomes in patients with placenta acreata spectrum (PAS).MethodsThe study group comprised 72 patients diagnosed with PAS who underwent surgery and received IV iron preoperatively. The control group consisted of 71 patients who underwent the same diagnosis but did not receive IV iron. We recorded and compared the groups’ demographic and obstetric findings, laboratory results, preoperative and postoperative blood product requirements, operation duration, characteristics, hospital stay, and neonatal outcomes.ResultsWe compared the IV iron group’s data to that of the control group and found that the study group needed significantly less erythrocyte suspension (ES) transfusions during surgery (32 (44.4%)) and after surgery (56 (77.8%)) than the control group (p < 0.05). Total ES transfusion requirement (1.38 ± 0.896) and total fresh frozen plasma (FFP) transfusion requirement (0.55 ± 0.785) in the study group were significantly less than the control group (p < 0.05). Postoperative hospital stay (hours) was also significantly shorter in the study group (56.34 ± 15.06) than in the control group (83.18 ± 21.64) (p < 0.05). The use of Bakri balloon tamponade was significantly higher in the control group (38 (52.8%)) than in the study group (12 (16.9%)) (p = 0.00), and the number of bilateral hypogastric artery ligations and total abdominal hysterectomy was significantly lower in the study group (13 (18.1)/2.8) than in the control group (53 (74.6)/19 (26.8)) (p < 0.05). There was no statistically significant difference between the groups in terms of the use of compression sutures, lower uterine segment resection, or adjacent organ damage (p > 0.05).ConclusionsPreoperative IV iron administration positively affects intraoperative bleeding, operative time, blood product requirement, peripartum hysterectomy requirement, and hospital stay.

Objectives Iron deficiency anemia (IDA) is a common extraintestinal manifestation of inflammatory bowel disease (IBD), driven by impaired iron absorption, inflammation of intestinal mucosa and blood loss due to intestinal bleeding. Exogenous iron is indicated to correct iron deficiency, with intravenous iron preferred in patients with malabsorption or intolerance of oral iron, active bleeding, systemic inflammation, or a need for rapid iron replenishment. The objective was to assess the cost-utility of two high-dose, rapid-infusion iron formulations—ferric derisomaltose (FDI) and ferric carboxymaltose (FCM)—in the treatment of patients with IBD and IDA in Sweden. Methods The analysis used a previously-published micro-simulation model. Phosphate monitoring was modeled based on the product labelling, while iron need and disease-related quality of life (QoL) were modeled based on data from the PHOSPHARE-IBD randomized controlled trial. Cost-utility was evaluated from the national healthcare payer perspective over a five-year time horizon. Sensitivity and scenario analyses were performed. Results For each iron treatment course, patients treated with FDI required 0.41 fewer infusions than those treated with FCM. The reduced number of infusions resulted in savings of SEK 9,876 over five years from iron administration costs alone (SEK 44,216 with FCM versus SEK 34,340 with FDI). Phosphate monitoring in patients treated with FCM cost SEK 2,776 over five years versus no monitoring costs with FDI. Total cost savings with FDI were SEK 14,962. FDI also resulted in a 0.076 quality-adjusted life year (QALY) improvement versus FCM driven primarily by the QoL improvements reported in PHOSPHARE-IBD, and FDI was therefore the dominant intervention. Limitations The analysis did not capture costs or outcomes associated with hypophosphatemic osteomalacia or fractures. Conclusion Relative to FCM, fewer infusions of FDI were required, there was no need for phosphate monitoring, and disease-related QoL was improved, while overall costs were reduced.

To provide evidence-based guidance on practical aspects and potential safety concerns (infusion reactions and hypophosphataemia) related to the use of intravenous iron from a nursing perspective. A modified Delphi consensus method. Literature searches were conducted and used to support the development of 16 consensus statements. Six nurses with expertise in the field of gastroenterology and experience with the administration of intravenous iron participated in a modified Delphi process to develop a final set of statements. Overall, 16 statements achieved consensus and covered the practicalities of administration, infusion reactions and hypophosphataemia. Patient preparation is a key step in the administration of intravenous iron, but information should be communicated carefully to prevent undue anxiety. Highlighting the nurse's confidence in the management of any reactions may help to reduce anxiety. The patient should be observed during the first 5-10 min of an infusion to allow prompt management of immediate infusion reactions, although severe hypersensitivity reactions are rare. Nurses should be vigilant for symptoms of hypophosphataemia (such as fatigue, weakness and muscle/bone pain), which can develop following treatment with ferric carboxymaltose, saccharated ferric oxide and iron polymaltose. Serum phosphate levels should be measured in patients receiving ferric carboxymaltose who are at risk of low phosphate. Infusion reactions and hypophosphataemia with intravenous iron are documented in the literature, but existing publications do not approach these topics from a nursing perspective. This consensus paper highlights the importance of patient preparation, monitoring and prompt management when administering intravenous iron to ensure patient safety. Considering that nurses have a central role in the administration of intravenous iron, the availability of evidence-based guidance is essential for both nurse confidence and patient safety. No patient or public contribution was involved in the consensus process.

Anaemia in patients having surgery is associated with worse postoperative outcomes. Management with intravenous iron is an attractive therapeutic option, however, pre-operative intravenous iron administration is challenging. Evidence from interventional trials suggests that the greatest benefit is after hospital discharge. As anaemia is common after surgery, this meta-analysis aimed to evaluate the efficacy of postoperative iron therapy to increase haemoglobin levels. Relevant databases were searched from inception to 6 April 2023. Randomised controlled trials in adults undergoing elective surgery with postoperative anaemia, comparing intravenous or oral iron with control groups were included. The primary outcome was haemoglobin level at the end of study. Secondary outcomes included quality of life; blood transfusion requirements; incidence of adverse events; requirement for readmission; and mortality. Fifteen randomised controlled trials including 1865 patients were identified. Seven studies investigated intravenous iron, six investigated oral iron and two compared intravenous with oral iron. Intravenous iron increased postoperative haemoglobin levels compared with placebo or no intervention (mean difference 4.51 g.l-1, 95%CI 2.63-6.38, I2 = 0%, p < 0.01), while oral iron was ineffective (mean difference 0.61 g.l-1, 95%CI -2.79-4.01, I2 = 23%, p = 0.66). The subgroup analysis identified patients after orthopaedic surgery as the group with the greatest benefit (mean difference 3.63 g.l-1, 95%CI 0.78-6.47, I2 = 20%, p = 0.02). There were no significant differences in the secondary outcomes. Our meta-analysis of iron therapy for treating anaemia after major surgery found that intravenous iron administered within 30 days of surgery increased haemoglobin levels effectively, whereas oral iron showed no benefit.