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A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia
Alhossain Khafalafallah, Abdul Majeed Al-Barzan, Johan Chan, Mei Fen Sung, Gerald Bates, Kiran Ahuja, John Batten and Bernie Einoder
Background: Improving preoperative anaemia is associated with a better surgical outcome. There is lack of data regarding treatment of preoperative anaemia with intravenous versus oral iron.
Objective: Assessment of efficacy of oral iron sulphate versus a single intravenous iron polymaltose and
subsequent effect on perceived quality of life in both treatment groups.
Patients and methods: We conducted a prospective randomised controlled trial with iron therapy for the
treatment of Iron Deficiency Anaemia (IDA) patients who were undergoing elective joint arthroplasty. At a single institution, we recruited 44 patients who were randomized to a single intravenous iron polymaltose infusion (16/22) versus oral daily iron sulphate (17/22). Median age was 68 years (range, 45-91) with a male to female ratio of 14:19.
Results: After iron therapy, the immediate mean preoperative Hb was increased to 128 g/L (SD ± 11.05) in the IV iron group versus 118 g/L (SD ± 9.23) in the oral iron group (p=0.01) compared to 116 g/L (SD ± 8.46) in the control group (p=0.001). The average length of stay in the hospital for the IV iron group was 6 days (SD ± 2.51) compared to 8 days (SD ± 3.62) in the oral iron group and 8 days (SD ± 4.18) in the control group (p=0.04). Average transfused blood units were 1.5 units in the IV iron group versus 2 units in the oral iron group (p=0.09) and 2.4 units in the control group (p = 0.04). There was a significant improvement of the symptoms of anaemia (p=0.03) after treatment in the IV versus oral iron group with further improvement at 3 months follow-up (p=0.003).
Conclusion: Our data suggest that IV iron therapy is superior to oral iron in improving preoperative Hb
and hence overall outcome for patients with preoperative IDA. Further trials that aim to improve and optimize preoperative and postoperative Hb are warranted.