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Preoperative Iron Supplementation in Pediatric Cardiac Surgical Patients: A Preliminary Single-Center Experience
Yoji Otsuka1, Nadia Naraine2, Timothy Switzer1
1Division of Cardiac Anesthesia, Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Preoperative iron supplementation increased hemoglobin levels in pediatric cardiac surgery patients. While transfusion rates didn't change, the volume of transfused blood significantly decreased, indicating improved patient blood management.
Area of Science:
- Pediatric Cardiac Surgery
- Patient Blood Management
- Anemia Management
Background:
- Cardiac surgery in children often involves significant blood loss and transfusion.
- Preoperative anemia is a risk factor for adverse outcomes in pediatric cardiac surgery.
- Implementing patient blood management (PBM) strategies aims to optimize preoperative hemoglobin levels and reduce transfusion needs.
Purpose of the Study:
- To evaluate the impact of a preoperative patient blood management (PBM) clinic with oral iron supplementation on preoperative hemoglobin levels and perioperative red blood cell transfusion in children undergoing cardiac surgery.
- To assess changes in transfusion volumes (allogeneic and autologous) following the PBM clinic implementation.
Main Methods:
- Retrospective analysis of 296 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.
- Comparison of patients before and after the implementation of a PBM clinic that included oral iron supplementation.
- Statistical adjustment for confounding factors including age, oxygen saturation, and type of congenital heart disease and surgery.
Main Results:
- Children receiving iron supplementation had significantly higher preoperative hemoglobin levels (13.9 g/dL) compared to historic controls (12.9 g/dL).
- The rate of red blood cell transfusion exposure was not significantly different between the groups (50% vs. 61%).
- Significantly reduced volumes of both allogeneic (1.4 mL/kg vs. 12.5 mL/kg) and autologous blood (11.0 mL/kg vs. 17.0 mL/kg) were transfused in the iron supplementation group.
Conclusions:
- Preoperative oral iron supplementation effectively increased preoperative hemoglobin levels in pediatric cardiac surgery patients.
- While transfusion rates remained similar, the volume of blood transfused decreased significantly.
- Further prospective randomized studies are recommended to confirm these findings and investigate long-term outcomes.
Objective:
To assess preoperative hemoglobin and perioperative red blood cell transfusion in children undergoing cardiac surgery after the implementation of a preoperative patient blood management (PBM) clinic with oral iron supplementation.
Design:
A retrospective analysis.
Setting:
A single tertiary hospital.
Participants:
Patients who underwent cardiac surgery with cardiopulmonary bypass at the Hospital for Sick Children (Toronto, Canada) during a 12-month period before and following the implementation of a preoperative PBM clinic. Patients younger than 3 months of age, or who were admitted to the cardiac intensive care unit preoperatively, were excluded because they were not systematically assessed by the PBM clinic.
Interventions:
None.
Measurements And Main Results:
A total of 296 patients were included in the authors' analysis. After adjustment for confounding factors (age at surgery, preoperative oxygen saturation, type of congenital heart disease, surgery type), they found that preoperative hemoglobin levels were significantly higher in children treated with iron supplementation (n = 201) compared to historic controls (n = 95) (13.9 [12.8-15.1] g/dL v 12.9 [11.7-15.0] g/dL, adjusted p = 0.001). The exposure rate to red blood cell transfusion (50% v 61%, adjusted p = 0.930) was not significantly different between groups. However, the volumes of allogeneic red blood cells (1.4 (0.0-14.0) mL/kg v 12.5 (0.0-23.0) mL/kg, adjusted p = 0.004) and autologous blood (11.0 (6.8-17.0) v 17.0 (11.0-31.0), adjusted p < 0.001) transfused were significantly reduced in children treated with iron supplementation.
Conclusions:
Preoperative iron supplementation led to an increase in preoperative hemoglobin levels. The exact prevalence of iron deficiency and the effect of iron supplementation on perioperative allogeneic blood transfusion and long-term outcomes should be studied in a prospective randomized study.
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