BJA Advance Access published online on March 27, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen054
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Perioperative anaemia management: consensus statement on the role of intravenous iron
1 Haematology Service, Geneva University Hospital, Geneva, Switzerland
2 Transfusion Medicine, School of Medicine, Malaga, Spain
3 Department of Haematology, Miguel Servet University Hospital, Zaragoza, Spain
4 Intensive Therapy Unit, Morriston Hospital, Swansea NHS Trust, Swansea, Wales, UK
5 Haematology Division, Henry Dunant Hospital, Athens, Greece
6 Department of Anaesthesiology, CHU Brugmann—HUDERF, Brussels, Belgium
* Corresponding author. E-mail: photis.beris{at}hcuge.ch
A multidisciplinary panel of physicians was convened by Network for Advancement of Transfusion Alternatives to review the evidence on the efficacy and safety of i.v. iron administration to increase haemoglobin levels and reduce blood transfusion in patients undergoing surgery, and to develop a consensus statement on perioperative use of i.v. iron as a transfusion alternative. After conducting a systematic literature search to identify the relevant studies, critical evaluation of the evidence was performed and recommendations formulated using the Grades of Recommendation Assessment, Development and Evaluation Working Group methodology. Two randomized controlled trials (RCTs) and six observational studies in orthopaedic and cardiac surgery were evaluated. Overall, there was little benefit found for the use of i.v. iron. At best, i.v. iron supplementation was found to reduce the proportion of patients requiring transfusions and the number of transfused units in observational studies in orthopaedic surgery but not in cardiac surgery. The two RCTs had serious limitations and the six observational limited by the selection of the control groups. Thus, the quality of the available evidence is considered moderate to very low. For patients undergoing orthopaedic surgery and expected to develop severe postoperative anaemia, the panel suggests i.v. iron administration during the perioperative period (weak recommendation based on moderate/low-quality evidence). For all other types of surgery, no evidence-based recommendation can be made. The panel recommends that large, prospective, RCTs be undertaken to evaluate the efficacy and safety of i.v. iron administration in surgical patients. The implementation of some general good practice points is suggested.
Keywords: blood, transfusion; complications, anaemia; surgery, cardiac, orthopaedic; surgery, postoperative period; surgery, preoperative period
Declaration of interest. Prof. P.B. has received lecture honoraria from Vifor International and has participated in a clinical trial approved by the institutional ethical committee and funded by Vifor International. Prof. A.M. has received lecture honoraria from Pharmacosmos.