Original article
Postoperative intravenous iron used alone or in combination with low-dose erythropoietin is not effective for correction of anemia after cardiac surgery

https://doi.org/10.1053/j.jvca.2003.10.012Get rights and content

Abstract

Objectives: The aim of this study was to examine whether intravenous iron III-hydroxide sucrose complex (IHSC) used alone was sufficient to provide rapid correction of anemia after cardiac surgery and whether additional stimulation of erythropoiesis is possible by means of a single low dose of recombinant-human erythropoietin (r-HuEPO) administration.

Design: Prospective, randomized, double-blind study.

Setting: The study was conducted in a university hospital.

Participants: One hundred twenty American Society of Anesthesiologists II or III patients, who underwent elective cardiac surgery using cardiopulmonary bypass and in whom postpump hemoglobin ranged between 7 and 10 g/dL.

Interventions: Patients were divided into 3 groups: group I = control; group II received postoperative intravenous iron supplementation with an iron III-hydroxide sucrose complex (IHSC); and group III received IV iron and a single dose of r-HuEPO (300 U/kg).

Measurements and results: No significant difference in transfusion needs was observed among the 3 groups (22%, 25%, and 17% of patients transfused in groups I, II, and III, respectively). Hemoglobin levels, reticulocyte counts, and serum ferritin levels were evaluated at different time intervals (until day 30 postoperatively). No side effects because of iron administration were noted in the study. Reticulocyte counts increased rapidly at day 5 (2.24% ± 1.11%, 1.99% ± 1.44%, and 3.84% ± 2.02% in groups I, II, and III, respectively) and decreased after day 15 in the 3 groups. Ferritin levels increased significantly at day 5 in the 2 treated groups (899.33 ± 321.55 ng/mL in group II, 845.75 ± 289.96 ng/mL in group III v 463.15 ± 227.74 ng/mL in group I). In group I, ferritin levels, after a slight elevation on day 5, decreased at day 15 to lower than baseline levels. No significant difference in hemoglobin increase was noted among the 3 groups.

Conclusion: Postoperative intravenous iron supplementation alone or in combination with a single dose of r-HuEPO (300 U/kg) is not effective in correcting anemia after cardiac surgery.

Section snippets

Material and methods

The local hospital ethical committee approved the study protocol. An informed consent was obtained from all the patients preoperatively. Between August 1998 and December 1999, 120 American Society of Anesthesiologists II or III patients, who underwent elective cardiac surgery using cardiopulmonary bypass and in whom postpump hemoglobin ranged between 7 and 10 g/dL, were enrolled in a prospective randomized study.

Exclusion criteria were transfusion of allogeneic blood intraoperatively, pts with

Results

No mortality was noted in this series, and all pts could be followed for at least 30 days postoperatively. There were no significant differences among the 3 groups with regards to age, weight, sex, preoperative Hb level, and postoperative bleeding (Table 1). Twenty-six pts (26/120 = 22%) were transfused and excluded from the study: 9 pts (9/40 = 22%) in group I (placebo), 10 pts (10/40 = 25%) in group II (IHSC), and 7 pts (7/40 = 17%) in group III (IHSC + r-HuEPO). The numbers of units

Discussion

Anemia is commonly encountered after cardiac surgery. It is usually corrected either by blood transfusions or by erythropoiesis stimulation. Blood transfusions can be allogeneic or autologous. It is universally accepted that allogeneic blood transfusions (ABTs) should be avoided whenever possible. This is related to the fact that ABTs are associated with a risk of transmission of viral infections as well as febrile and hemolytic reactions.9, 10 Many strategies have been developed to avoid ABTs.

References (37)

  • L YazicioGlu et al.

    Recombinant human erythropoietin administration in cardiac surgery

    J Thorac Cardiovasc Surg

    (2001)
  • R Fletes et al.

    Suspected iron dextran-related adverse drug events in hemodialysis patients

    Am J Kidney Dis

    (2001)
  • Y Watanabe et al.

    Subcutaneous use of erythropoietin in heart surgery

    Ann Thorac Surg

    (1992)
  • B Skikne et al.

    Effect of enhanced erythropoiesis on iron absorption

    J Lab Clin Med

    (1992)
  • L.A Laine et al.

    Effect of oral iron therapy on the upper gastrointestinal tract. A prospective evaluation

    Dig Dis Science

    (1988)
  • D.S Silverberg et al.

    Intravenous ferric saccharate as an iron supplement in dialysis

    Nephron

    (1996)
  • C Breymann et al.

    Use of recombinant human erythropoietin in combination with parenteral iron in the treatment of postpartum anaemia

    Eur J Clin Invest

    (1996)
  • K Yasuura et al.

    Transfusion-associated graft-versus-host disease with transfusion practice in cardiac surgery

    J Cardiovasc Surg

    (2000)
  • Cited by (0)

    View full text