Management of preoperative anemia: iron replacement

Abstract

Preoperative anaemia is prevalent in surgical patients and is associated with worse patient outcomes. Iron deficiency (ID), either absolute or functional is the leading cause of anaemia in this patient population. Therefore, in the surgical setting iron supplementation seems to be central to the implementation of the first pillar of Patient Blood Management(PBM).

Oral iron salts may be useful for the preoperative treatment of ID and mild to moderate iron deficiency anaemia (IDA), as well as replenishing low iron stores, provided there is adequate tolerance and sufficient time. The role of the newer oral iron formulations (e.g, sucrosomial iron) with greater iron bioavailability and improved gastrointestinal tolerance are currently being evaluated.

Intravenous (IV) iron has been demonstrated as a safe and effective alternative for patients who have intolerance or contraindication to oral iron, anaemia with inflammation, moderate to severe anaemia, persistent bleeding, or a short time before major surgery (≤4 weeks). IV iron formulations allowing administration of high doses (1,000-1,500 mg) in a single session (e.g., ferric derisomaltose) facilitate treatment and may be more cost-effective and patient centred than multiple lower dose infusions.