[Iron homeostasis in preoperative autologous blood donation]

The role of iron metabolism, the value and the limits of oral as well as intravenous iron substitution in preoperative autologous blood donation are discussed according to the literature.

The critical review of the German and English literature is based on a Medline backsearch covering the last 20 years.

The success of preoperative autologous blood donation substantially depends on the volume of whole-body iron and on the amount of storage iron which is available at the beginning of the donation phase. Since iron losses due to repeated blood donations within a few weeks cannot be replaced sufficiently by food, medical iron substitution seems to be appropriate. Nevertheless, hitherto neither oral nor intravenous iron substitution could be demonstrated as useful instruments for an improvement of erythropoietic response in non iron deficient patients after autologous blood donation. Merely, intravenous iron used in combination with recombinant erythropoietin seems to be an effective support for erythropoiesis during predeposit.

At the moment intravenous iron medication in autologous blood donation should be restricted to well-established exceptional cases. The use of intravenous iron combined with erythropoietin seems to be justified to avoid ineffective erythropoieses and to achieve a dose reduction of recombinant erythropoietin. Since there are nearly no risks and a possible efficacy cannot be totally excluded, oral iron supplementation may be applied to patients who tolerate it well. Real iron deficiency has to be treated with iron application. Further clinical studies have to be done for a final validation of the efficacy of iron substitution in non iron deficient preoperative autologous blood donors.