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Iron supplementation for postoperative anaemia following major paediatric orthopaedic surgery
Kelvin K W Lau1, Murali M Utukuri, Manoj Ramachandran
1Orthopaedic Department, Great Ormond Street Hospital for Children NHS Trust, London, UK. jarrungmed@hotmail.co.uk
Insights
Routine iron supplementation for postoperative anemia in pediatric orthopedic surgery is often unnecessary and should be discontinued. This practice persists despite evidence that surgical anemia is not typically iron-deficient and oral iron has side effects.
Area of Science:
- Pediatric Orthopedic Surgery
- Anemia Management
- Pharmacological Interventions
Background:
- Surgical anemia is increasingly recognized as non-iron deficient.
- Oral iron supplementation poses dose-dependent side effects, especially in children.
- Current practices for managing postoperative anemia lack standardization.
Purpose of the Study:
- To survey UK pediatric orthopedic units on postoperative anemia management.
- To assess the prevalence of iron supplementation post-surgery.
- To evaluate adherence to evidence-based anemia treatment protocols.
Main Methods:
- National survey of 23 major UK pediatric orthopedic surgical units.
- Structured questionnaire administered to middle-grade doctors and charge nurses.
- Inquiry focused on management of anemia after major hip, pelvic, and spinal surgery.
Main Results:
- Only 4.3% of units had a formal protocol for postoperative anemia.
- 43.5% of units did not routinely prescribe iron postoperatively.
- Most units prescribed iron based on hemoglobin levels or without assessing iron deficiency.
Conclusions:
- Iron supplementation is frequently used for postoperative anemia in pediatric orthopedics without confirmed iron deficiency.
- Routine iron supplementation is not supported by current evidence.
- A cessation of routine iron supplementation for this patient group is recommended.
Introduction:
There is increasing evidence that the anaemia of surgery is not iron deficient and is, therefore, unresponsive to iron supplementation. Oral iron is best avoided postoperatively, particularly in children, due to its dose-dependent side effects. We undertook a national survey of major paediatric orthopaedic surgical units in the UK to investigate the current management of postoperative anaemia with particular reference to iron supplementation.
Materials And Methods:
Middle-grade doctors and charge nurses at 23 major paediatric orthopaedic units in the UK were contacted by telephone and a structured questionnaire was used to determine the management of postoperative anaemia in major hip, pelvic and spinal surgery.
Results:
Only one (4.3%) of the units surveyed had a formally established protocol for the management of postoperative anaemia. Only 10 out of 23 units (43.5%) did not routinely prescribe iron postoperatively. Of the remaining units, 11 commenced iron based on the postoperative haemoglobin level while only 2 used iron supplementation after investigation of serum haematinics for iron deficiency. One unit used erythropoietin in the treatment of postoperative anaemia.
Conclusions:
Iron supplementation continues to be used in major paediatric orthopaedic surgery in the treatment of postoperative anaemia in the absence of iron deficiency. Given the current available evidence, we call for an end to the practice of routine iron supplementation for postoperative anaemia following major paediatric orthopaedic surgery in the UK.
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