Iron therapy for preoperative anaemia

Area of Science:

• Anesthesiology
• Hematology
• Surgery

Background:

• Preoperative anemia is prevalent, affecting 5-76% of patients.
• It increases risks of blood transfusions, longer hospital stays, and mortality.
• Iron deficiency is a common cause, treatable with oral or intravenous iron.

Purpose of the Study:

• To evaluate preoperative iron therapy's effectiveness in reducing allogeneic blood transfusions in anemic surgical patients.
• To summarize evidence on enteral and parenteral iron for preoperative anemia management.

Main Methods:

• Included randomized controlled trials (RCTs) comparing preoperative iron to placebo, no treatment, or other iron therapies.
• Defined anemia as hemoglobin <13 g/dL (males) or <12 g/dL (females).
• Collected data on transfusion rates, hemoglobin, ferritin, quality of life, and morbidity.

Main Results:

• Six RCTs (372 participants) evaluated iron therapy; analysis was underpowered.
• No significant difference in blood transfusion rates between iron therapy and placebo/standard care (moderate-quality evidence).
• Intravenous iron increased preoperative hemoglobin and ferritin more than oral iron (low-quality evidence).

Conclusions:

• Iron therapy for preoperative anemia did not significantly reduce allogeneic blood transfusions.
• Evidence on intravenous vs. oral iron is not yet reliable.
• Further large, well-designed RCTs are needed to confirm effectiveness.