ORAL IRON THERAPY FOR ANAEMIA AFTER ORTHOPAEDIC SURGERY: RANDOMIZED CLINICAL TRIAL

Weatherall M, Maling TJ

Article

Concerns over the risks of blood transfusion and the evidence that substantial anemias can be safely tolerated for brief periods by many patients have led to the widespread adoption of conservative transfusion policies in the perioperative setting. However, postoperative anemia may result in fatigue, weakness, and impaired functional capacity, and impede the ability of elderly patients to participate in rehabilitation. In view of the impact of postoperative anemia on quality of life, the efficacy of methods used to improve hemoglobin levels after surgery are a critical issue. In this double-blind, randomized controlled trial of 72 patients with normal iron stores undergoing elective hip or knee surgery at a single orthopedic center in New Zealand, oral iron supplementation did not significantly improve mean Hb concentration nor the rate of change in Hb concentrations within 10 weeks after surgery, compared to folic acid administration. This study has a major limitation: it is not placebo-controlled, but compared oral iron to folic acid, another hematinic agent. Nevertheless, this work points to the limited efficacy of oral iron in correcting postoperative anemia and suggests that more effective treatments, including intravenous iron, need to be evaluated in well-designed trials.