Does the preoperative iron status predict transfusion requirement of orthopedic patients?

In patients scheduled for major orthopedic surgery, the presence of anemia before surgery can preclude the transfusion requirements. Iron deficiency anemia is believed to be a major cause of anemia, especially in the elderly. The importance of screening patients undergoing major orthopedic surgery in Norway for anemia and iron deficiency has not been investigated. The aim of the present study was to investigate if preoperative testing of iron status could predict transfusion requirement related to major elective orthopedic surgery.

Retrospective and prospective investigations were carried out on patients undergoing major elective orthopedic surgery on knee and hip arthroplasty. Patients were screened for hemoglobin, hematocrit, CRP and iron status (s-ferritin, s-iron, s-total iron binding capacity) before surgery. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 15.0.

There was no correlation between the iron status before surgery and the need for transfusion during and after surgery, although anemia before surgery was a predictor for the need for transfusion. Based in our limited study we could not recommend iron status screening before surgery. However further studies are needed to truly establish the incidence and the underlying etiology, in order to reduce the transfusion requirements.