Iron therapy
Pro Research Analysisby 
Searched over 200M research papers for "iron therapy"
Consensus Meter
Iron Therapy: Efficacy, Safety, and Applications
Preoperative Anemia and Iron Therapy
Preoperative Anemia Prevalence and Risks
Preoperative anemia is a common condition, affecting between 5% to 76% of patients undergoing surgery. It is associated with increased risks of perioperative allogeneic blood transfusions, longer hospital stays, and higher morbidity and mortality rates .
Iron Deficiency as a Primary Cause
Iron deficiency is a leading cause of preoperative anemia. Both oral and intravenous (IV) iron therapies are used to treat this condition. However, IV iron has shown greater efficacy in rapidly correcting iron stores in various conditions, including inflammatory bowel disease, chronic heart failure, and postpartum hemorrhage .
Efficacy of Iron Therapy in Preoperative Settings
Studies have shown mixed results regarding the efficacy of iron therapy in reducing the need for blood transfusions in preoperative patients. Meta-analyses indicate no significant reduction in the proportion of patients requiring transfusions when comparing iron therapy to placebo or standard care . However, IV iron has been associated with a greater increase in hemoglobin and ferritin levels compared to oral iron .
Intravenous Iron Therapy: Efficacy and Safety
Hemoglobin and Transfusion Requirements
IV iron therapy has been shown to effectively increase hemoglobin levels and reduce the need for red blood cell transfusions. A meta-analysis of 75 trials involving 10,605 patients found that IV iron significantly increased hemoglobin concentrations and reduced transfusion requirements, especially when used with erythroid stimulating agents (ESAs) or in patients with lower baseline ferritin levels. Another study confirmed that IV iron therapy modestly increased hemoglobin levels in critically ill adults, although it did not significantly reduce transfusion requirements.
Risk of Infection
While IV iron therapy is effective, it is associated with an increased risk of infection. The same meta-analysis reported a significant increase in infection risk among patients receiving IV iron compared to those receiving oral or no iron supplementation. However, another study found no significant difference in infection rates in ICU patients receiving iron therapy.
Oral vs. Intravenous Iron Therapy
Postpartum Anemia
In the context of postpartum anemia, IV iron has been found to be more effective than oral iron. A systematic review of 15 randomized trials showed that women receiving IV iron had higher hemoglobin and ferritin concentrations at various postpartum weeks compared to those receiving oral iron. Additionally, IV iron was associated with fewer gastrointestinal side effects, such as constipation and dyspepsia.
Pediatric Hemodialysis Patients
For pediatric patients undergoing hemodialysis, IV iron was more effective than oral iron in increasing serum ferritin levels and reducing the dose of recombinant human erythropoietin (r-HuEPO) required. However, both forms of iron maintained patients in an iron-replete state.
Postoperative Iron Therapy
Efficacy in Postoperative Settings
The efficacy of iron therapy in treating postoperative anemia is less clear. A systematic review found that postoperative oral and IV iron therapies were ineffective in significantly improving quality of life or reducing the risk of blood transfusions. IV iron did increase hemoglobin levels, but the increase was not deemed clinically meaningful.
Conclusion
Iron therapy, particularly IV iron, is effective in increasing hemoglobin levels and reducing transfusion requirements in various clinical settings. However, its use is associated with an increased risk of infection. While IV iron is more effective than oral iron in certain conditions, such as postpartum anemia and pediatric hemodialysis, the overall benefits and risks must be carefully weighed. Further research is needed to establish the true efficacy and safety of iron therapy in different patient populations.
Sources and full results
Most relevant research papers on this topic