Iron therapy for pre-operative anaemia.

Area of Science:

• Medical research
• Clinical trials
• Evidence-based medicine

Background:

• Pre-operative anaemia affects up to 76% of patients, increasing risks of transfusions, longer hospital stays, and mortality.
• Iron deficiency is a primary cause of anaemia, with oral iron historically used, but parenteral iron shows promise in other conditions.
• Limited studies exist on iron therapy for pre-operative anaemia, necessitating a review of current evidence.

Purpose of the Study:

• To evaluate the effectiveness of pre-operative iron therapy (enteral or parenteral) in reducing allogeneic blood transfusions for anaemic surgical patients.

Main Methods:

• Searched multiple databases including Cochrane, MEDLINE, EMBASE, CINAHL, and PubMed up to March 2015.
• Included randomized controlled trials (RCTs) comparing pre-operative iron monotherapy against placebo, no treatment, standard care, or other iron forms in anaemic adults undergoing surgery.
• Collected data on blood transfusions, units transfused, and hemoglobin levels; analyzed using Cochrane statistical software.

Main Results:

• Three RCTs with 114 patients evaluated pre-operative iron therapy (oral vs. standard care, IV vs. control, oral vs. IV).
• Meta-analysis showed a non-statistically significant reduction in blood transfusions (RR 0.56, 95% CI 0.27 to 1.18).
• Intravenous iron increased hemoglobin more than oral iron (MD 1.90 g/dL), but this finding had a high risk of bias due to compliance exclusions.

Conclusions:

• Current evidence from three small RCTs does not statistically confirm iron therapy's benefit in reducing pre-operative blood transfusions.
• The study sample size was insufficient to detect a clinically significant reduction in transfusions.
• Further large, well-designed RCTs are required to establish the efficacy of iron therapy for pre-operative anaemia.