Preoperative intravenous iron administration corrects anemia and reduces transfusion requirement in women undergoing abdominal hysterectomy

Abstract

We prospectively investigated the utility of preoperative intravenous (IV) iron treatment to increase hemoglobin (Hb) levels and reduce the need for transfusion in women with iron deficiency anemia (IDA) or iron deficiency (ID) scheduled for elective abdominal hysterectomy. Seventy-five women with ID or IDA were enrolled in the study. Women having their surgical procedure at least 1 month after preoperative assessment received IV iron sucrose during 2-4 weeks (IV iron group, n = 31). Women having their surgical procedure a few days after preoperative assessment did not receive IV iron (control group, n = 44). At baseline, there were no differences between the two groups in terms of weight or age, prevalence of anemia, Hb levels or iron laboratory parameters. IV iron sucrose (760 ± 290 mg) increased preoperative Hb (∆ Hb: 2.2 ± 1.2 g/ dL; P < 0.001) and reduced postoperative transfusion rates when compared with the control group (32% vs. 0%, respectively; P < 0.001). In addition, fewer women from the IV iron group were anemic on postop-erative day 21 (23% vs. 68%, respectively; P < 0.01). No life-threatening iron sucrose adverse effect was observed. Because of the rapid increase in Hb levels, IV iron sucrose administration seems to be an effective approach for treating preoperative anemia and reducing transfusion rates in this female population. In gynecological practice, the greatest number of allo-geneic blood transfusions (ABT) occur during hysterectomy , which is a major gynecological operative procedure commonly indicated for women with dys-functional bleeding, uterine leiomyomas, prolapse, endometriosis and adenomyosis, pelvic pain, premalignant conditions and cancer. Usually, ABT is prompted by surgical blood loss in an already anemic woman, although some women also receive preopera-tive ABT because of severe anemia. Since the introduction of gonadotropin-releasing hormone, only 5% of women who undergo vaginal hysterectomy for menor-rhage are transfused. 1 However, women who undergo abdominal gynecological surgery are frequently exposed to ABT and ABT-related risks. 1 Given that many of these women present with iron deficiency Keywords • Abdominal hysterectomy • Anemia • Blood transfusion • Intravenous iron