202501072210
Status:
Tags: Haematology
anaemia
WHO defines anaemia as a haemoglobin (hb) <13 g/dL in men and <12 g/dL in non-pregnant women, although there have been calls to use an hb target of 13 in both sexes for peri-operative management
| Ferritin level (µg/litre) | Transferrin saturations | Likely diagnosis |
|---|---|---|
| <30 | <20% | Iron deficiency |
| 30–100 | <20% | Functional iron deficiency |
| >100 | >20% | Not iron deficient consider B12/folate levels or refer to haematology |
PREVENTT trial is the first randomized control trial (RCT) to test whether a single dose of iron, if given pre-operatively, affects surgical outcome.
The trial demonstrated an ↑ in hb and ↓ hospital readmission in the treatment group but found no difference in transfusion rates or mortality
this trial did not stipulate that anaemia was caused by iron deficiency and therefore may be underpowered
There is growing recognition of the importance of identifying and treating patients with iron deficiency without anaemia (IDWA). There is some evidence that iron replacement in patients with IDWA can reduce blood transfusion rates in cardiac surgery. There is also evidence that treating iron deficiency with or without anaemia can improve quality of life and functional status of patients with heart failure
IRONMAN trial showed improved health-related quality of life at 4 months following IV iron, but failed to find statistical significance for its primary endpoint of cardiovascular deaths and hospital admissions for heart failure.
These results were similar to those found in the AFFIRM-AHF trial.
However, a recent meta-analysis pooling seven studies did find a statistically significant ↓ in hospital admissions for heart failure when iron deficient patients were given IV iron