This Article Résumé de cet Article Full Text Full Text (PDF) Additional Material Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Karkouti, K. Articles by Yau, T. M. Search for Related Content PubMed PubMed Citation Articles by Karkouti, K. Articles by Yau, T. M.

Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia

[L’administration intraveineuse de fer et d’érythropoïétine recombinante pour le traitement de l’anémie postopératoire]

Keyvan Karkouti, MD^*,, Stuart A. McCluskey, MD^*, Mohammed Ghannam, BSc^*, Mary-Jane Salpeter, RN^*, Ian Quirt, MD and Terrence M. Yau, MD

^* From the Departments of Anesthesia, Health Policy, Management, and
Evaluation, Division of Hematology; and
the Division of Cardiac Surgery,
University of Toronto, University Health Network, Toronto, Ontario, Canada.

Address correspondence to: Dr. Keyvan Karkouti, Toronto General Hospital, University Health Network, Department of Anesthesia, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. Phone: 416-340-5164; Fax: 416-340-3698; E-mail: keyvan.karkouti{at}uhn.on.ca

Purpose: To determine if early recovery from severe post-operative anemia is accelerated by iv iron therapy alone or in combination with recombinant erythropoietin (EPO).

Methods: In this double-blinded, placebo-controlled randomized study, consenting adult patients without preoperative anemia whose hemoglobin concentration (Hb) was 70 to 90 g·L^–1 on the first day after cardiac or orthopedic surgery (POD 1) were assigned to one of three groups: control, iv iron alone (200 mg of iron sucrose on POD 1, 2, and 3) or in combination with EPO (600 U·kg^–1 on POD 1 and 3). The primary outcome was increase in Hb (adjusted for red blood cell transfusions) from POD 1 to 7. Analysis was by intention-to-treat in patients for whom the primary outcome was available. Group effect was analyzed by the ANOVA test, and between-group differences were specified with a Duncan multiple-range test.

Results: The primary outcome was available in 31 of 38 randomized patients. The average POD 1 Hb was 84 ± 4 g·L^–1. There were no between-group differences in outcomes except for higher reticulocyte counts on POD-7 in the combination group. The average adjusted one-week increases in Hb were 7 ± 8 g·L^–1 in the control group (n = 10), 9 ± 9 g·L^–1 in the iv iron group (n = 11), and 10 ± 14 g·L^–1 in the combination group (n = 10). The average adjusted six-week increases in Hb were 37 ± 14 g·L^–1 in the control group, 40 ± 7 g·L^–1 in the iv iron group, and 45 ± 12 g·L^–1 in the combination group.

Conclusion: Early postoperative treatment with iv iron alone or in combination with EPO does not appear to accelerate early recovery from postoperative anemia.

This article has been cited by other articles:

				P. Beris, M. Munoz, J. A. Garcia-Erce, D. Thomas, A. Maniatis, and P. Van der Linden Perioperative anaemia management: consensus statement on the role of intravenous iron Br. J. Anaesth., May 1, 2008; 100(5): 599 - 604. [Abstract] [Full Text] [PDF]