JMIR Publications

ABSTRACT

Background:

An iron infusion pathway using Ferrinject®(ferric carboxymaltose) was implemented at Southend University Hospital for pre-operative surgical patients with iron deficiency anaemia undergoing major surgery. This was based on a treatment algorithm proposed by Munting et al, based on the international consensus statement on peri-operative management of anaemia and NICE guidelines. This states intravenous iron is indicated when oral iron is poorly tolerated, ineffective, there is insufficient time to surgery, or due to functional iron deficiency.

Objective:

Our objective was to study the degree of change in adult haemoglobin concentration (Hb g/L) after infusion at the time of surgery.

Methods:

Data was retrospectively collected on all surgical patients that received an iron infusion pre-operatively for iron deficiency anaemia from July 2019 to April 2020. Non-surgical patients, obstetrics, paediatrics and those without a post infusion haemoglobin level were excluded. Data collected included: pre and post infusion Hb, ferritin, and transferrin (post infusion results closest to surgery were collected), correct or incorrect dose of IV iron received (dose based on baseline Hb and weight) and any adverse reactions noted.

Results:

32 surgical patients with iron deficiency anaemia received intravenous iron between July 2019 and April 2020 prior to surgery. The average pre and post iron infusion haemoglobin concentration across the cohort was 97 g/L and 114 g/L respectively (18% increase p= 0.001). 2 (6%) patients had a post transfusion Hb ≥ 130 g/L prior to surgery after infusion. 9 patients had both a pre and post infusion ferritin level recorded which showed an increase from 12 μg/L pre infusion to 94 μg/L (p=0.02) post infusion. 23 (72%) patients were did not receive the full dose of IV iron based on their Hb and weight. 75% of patients received an iron infusion >2 weeks prior to surgery with 25% < 2 weeks before their surgery. There was an average increase in Hb of 22% (21 g/L 95% CI 13-28) and 5% (5 g/L 95% CI 1-10) (p=0.03) respectively across the two groups. There were no documented adverse reactions to the infusion.

Conclusions:

IV iron is an effective intervention to improve haemoglobin concentration in iron deficiency anaemia despite the majority of cases not receiving the full dose of IV iron based on their baseline Hb and weight. Increasing interval time between infusion and surgery was associated with a greater increase in Hb with only a minimal increase seen if given less than 2 weeks before.