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A Trial of Preoperative IV Iron Sucrose (Venofer) Supplementation in Patients with Iron Deficiency Anaemia Undergoing Hip Arthroplasty at the Royal Bournemouth Hospital
Author(s) -
Burt T.,
Lim S.,
Hall R.,
Locke K.,
Brannan L.,
Johnson J.,
Clark M.
Publication year - 2006
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.1365-3148.2006.00694_11.x
Subject(s) - medicine , iron deficiency , iron sucrose , iron supplementation , blood count , anemia , hip arthroplasty , blood transfusion , surgery , iron therapy , intravenous iron , arthroplasty , pediatrics
We present the protocol and initial results for a trial of preoperative IV iron in anaemic patients presenting for hip arthroplasty at The Royal Bournemouth Hospital (RBH). A review of audit data at RBH has revealed 30% of primary hip replacements receive blood transfusion of at least 2 units of red cells. These patients often present to preoperative assessment clinic with a low haemoglobin (Hb). A proportion of patients with a low Hb are iron deficient. In patients with iron deficiency anaemia, oral iron therapy is frequently poorly tolerated and a rise in Hb following oral iron is slow making it unsuitable to use in the preoperative setting. IV Iron Sucrose (Venofer, Synermed Pharmaceutical Products Limited) provides predictable bioavailable iron and has an low allergenic potential. It is safe and quick to give in an outpatient setting. In addition it is a cheap alternative to allogeneic blood. At RBH approximately 20 anaemic patients present monthly to orthopaedic pre‐assessment clinic for hip arthroplasty. These patients have a Hb <120 g dL −1 (female) or Hb <130 g dL −1 (male) and currently proceed to surgery with no further investigation unless Hb <10 g dL −1 . A proportion of these patients will have iron deficiency anaemia and are therefore amenable to preoperative treatment with IV iron therapy. Study protocol flags up anaemic patients for further investigation to the Haematology Specialist Registrar (SpR) who sends a further blood form and patient information about the IV iron replacement trial. Blood tests include FBC and blood film, iron studies (ferritin, serum Fe, TIBC, transferrin saturation), coagulation screen, ESR, renal and liver function tests. Patients found to have iron deficiency anaemia are consented for the trial at an appointment with the SpR and are randomised to receive IV Iron (Venofer) or ‘standard treatment’ (no therapy). Venofer patients receive 2–3 doses (formula calculated) of IV iron (Venofer bolus over 10 min) at weekly intervals. The FBC is checked after an initial two doses and a third dose given only if the patient is still anaemic. The hospital transfusion practitioner (HTP) gives the 1st dose at the time of consent. The subsequent doses are given at weekly intervals by the HTP. Patients who have iron deficiency anaemia are also referred to the iron deficiency clinic for further investigations. Primary end points are number of patients receiving blood transfusion and number of units of blood transfused. Secondary end points are discharge times from hospital and postoperative infection rates. We present our full protocol and data collection form. We also hope to present the results from the first patients recruited.