Anemia: Fast Facts (Peer reviewed publications)
Results of a double blind randomized controlled trial: iron supplementation after elective hip or knee surgery
Researchers from the Wellington School of Medicine and Health Sciences conducted a double blind randomized controlled trial in order to determine whether or not administration of oral iron after orthopedic surgery results in an improvement of hemoglobin levels. The primary endpoint was the hemoglobin level 10 weeks after surgery. The study was conducted on patients undergoing elective hip or knee replacement surgery, with no history of iron deficiency, and normal iron and folic acid stores. The researchers concluded, "Iron taken after elective hip or knee replacement surgery does not result in higher hemoglobin 10 weeks after surgery, or a faster rate of increase in hemoglobin than a control treatment."
NAAC Comments: The role of intravenous iron is still undetermined.
Weatherall M, Maling TJ. Oral iron therapy for anaemia after orthopaedic surgery: randomized clinical trial. ANZ J Surg. 2004;74(12):1049-51.
Retrospective review looks at relationship between patient outcomes after hip surgery and discharge hemoglobin
A retrospective review of 844 community-dwelling patients who had undergone surgery for hip fracture was conducted to evaluate the relationship between patient outcomes status post hip fracture and the last hemoglobin level prior to patient discharge. Anemia was defined as a hemoglobin of 12.0 g/dL in women and 13.0 g/dL in men. Health outcomes of interest were mortality, return to ambulatory ability, and return to activities of daily living at 3, 6, and 12 months. The review revealed patients were less likely to be anemic if they had sustained a femoral neck fracture and undergone internal fixation, versus patients who had sustained an intertrochanteric fracture or patients treated for femoral neck fractures with hemiarthroplasty. The researchers concluded, "Patients with anemia at the last discharge were not at increased risk for adverse outcomes at 3, 6, or 12 months compared with patients who did not have anemia."
Su H, Aharonoff GB, Zuckerman JD, et al. The relation between discharge hemoglobin and outcome after hip fracture. Am J Orthop. 2004 Nov;33(11):576-80.
A meta-analysis of randomized, controlled trials studying hemoglobin targets for the anemia of chronic kidney disease
Researchers did a meta-analysis to evaluate the benefits and harms of different hemoglobin targets in chronic kidney disease (CKD). The data were gathered from databases such as the Cochrane Trials Registry, Medline, and Embase, and reference lists. The review identified 19 randomized clinical trials of relevance. A comparison of CKD patients with hemoglobin values >13.0 g/dL and CKD patients with hemoglobin values <12.0 g/dL revealed hemoglobin values <12.0 g/dL were associated with lower all-cause mortality, and hemoglobin values </= 10.0 g/dL reduced the risk of hypertension. The risk of seizures did increase with a hemoglobin of 10.0 g/dL. The researchers stated, "From the available trial evidence, in CKD patients with cardiovascular disease, the benefits associated with higher Hb targets (reduced seizures) are outweighed by the harms (increased risk of hypertension and death)."
NAAC Comments: The results of these Meta-analysis of several studies conducted over a long period of time (20 years?) need to be considered in the light of provision of best care. Meta-analysis cannot control for individual management of hypertension nor for the evolving management of heart failure. Furthermore, other outcomes, such as cognitive effects were not taken into account.
Strippoli GF, Craig JC, Manno C, et al. Hemoglobin targets for the anemia of chronic kidney disease: a meta-analysis of randomized, controlled trials. J Am Soc Nephrol. 2004;15(12):3154-65.
Surgery Today reports findings of a retrospective study: preoperative iron supplementation in patients undergoing colorectal cancer surgery reduces the need for intraoperative transfusion
Japanese researchers reported the findings of a retrospective study designed to investigate whether anemia was improved and intraoperative blood transfusion reduced by giving an iron preparation to anemic patients before colorectal cancer surgery. The records of 116 patients who underwent colorectal cancer surgery between 1998 and 2003 were studied. Group A consisted of 32 anemic patients who had received iron supplementation for 2 weeks prior to surgery, and group B consisted of 84 patients who did not receive the presurgical iron supplementation. The study showed, although there were no significant differences in intraoperative blood loss between the groups and hemoglobin and hematocrit values were similar at first presentation, patients in group A required fewer intraoperative transfusions.
Their hemoglobin and hematocrit values were similar at first presentation, but significantly different immediately before surgery (both P < 0.0001). There were no significant differences in intraoperative blood loss between the groups, but significantly fewer patients in group A required intraoperative blood transfusion (9.4% vs 27.4%, P < 0.05). The researchers concluded, "Iron supplementation for at least 2 weeks before colorectal cancer surgery increases hemoglobin and hematocrit values in anemic patients, and reduces the need for intraoperative transfusion."
Okuyama M, Ikeda K, Shibata T, et al. Preoperative iron supplementation and intraoperative transfusion during colorectal cancer surgery. Surg Today. 2005;35(1):36-40.
Study demonstrates the value of utilizing reticulocyte-Y count as a measure of iron deficiency anemia versus anemia of chronic disease
Researchers from Johns Hopkins report, "The reticulocyte Y (Ret-Y) parameter has the highest overall sensitivity and specificity of the panel of tests routinely used in differentiating iron deficiency anemia (IDA) from anemia of chronic disease (ACD)." The study evaluated the laboratory parameter prospectively in 100 patients evaluated for anemia. Utilizing data from a complete blood count, peripheral smear, serum ferritin, and a history and physical examination, diagnoses were made (anemia of chronic disease or iron deficiency anemia). The researchers stated, "We analyzed the sensitivity and specificity of the Ret-Y in relation to the clinical diagnosis… and found Ret-Y correlated closely to the serum transferrin receptor and was superior to the mean corpuscular volume and ferritin level, in differentiating the type of anemia (IDA vs ACD)."
Kickler TS, Borowitz MJ, Thompson RE, et al. Ret-Y a measure of reticulocyte size: a sensitive indicator of iron deficiency anemia. Clin Lab Haematol. 2004;26(6):423-7.
Study looks at anemia in patients with prostate cancer
A study designed to evaluate patients with prostate cancer, and the effect of combined androgen block therapy on hematocrit and hemoglobin values, was reported in the Asian Journal of Andrology. The researchers studied 136 patients and found, "Hemoglobin and hematocrit levels declined significantly in all patients and at all time points after treatment." The study showed the degree of anemia in patients treated with combined androgen block therapy can be more serious than other therapies and may reduce erythropoiesis. The researchers concluded, "Patients exhibiting serious anemia with angina, dyspnea, or difficulty in respiration after androgen deprivation procedures can be treated with recombinant human erythropoietin."
Qian LX, Hua LX, Wu HF, et al. Anemia in patients on combined androgen block therapy for prostate cancer. Asian J Androl. 2004;6(4):383-4.
Iron deficiency anemia in early childhood and infancy
A review article discusses iron metabolism, and the clinical and laboratory features and treatment of iron-deficiency anemia (IDA). The authors state, "We propose a plan to prevent iron deficiency before anemia and clinical sequelae develop." The article reviews iron metabolism, and etiologies and clinical features of iron deficiency. In addition, the researchers discuss the diagnosis (and differential diagnoses) of IDA (clinical vs laboratory), and therapy and prevention. The researchers conclude, "Iron deficiency continues to plague children and adults, with infants and toddlers being at greatest risk for iron deficiency because of their rapid growth rates…Prevention of iron deficiency is paramount and can be accomplished with proper parental education and iron supplementation during the first 2 years of life."
Sandoval C, Jayabose S, Eden AN. Trends in diagnosis and management of iron deficiency during infancy and early childhood. Hematol Oncol Clin North Am. 2004;18(6):1423-38.
Anemia common and associated with shorter survival and progression-free survival in multivariate analysis of Southwest Oncology Group Study 8894
Researchers examined the prognostic value of anemia in 957 patients with newly diagnosed metastatic prostate cancer starting hormonal therapy. A logistic regression model was utilized to evaluate multivariate associations of disease and patient measures with anemia. The study showed an inverse association of anemia with prior therapy with curative intent, and with Gleason score 6 to 7 (vs 5 or less). The researchers concluded, "In this newly diagnosed metastatic prostate cancer sample, anemia was common and was associated with shorter survival, shorter PFS, and lower likelihood of PSAN with hormonal therapy after adjustment for disease status and other covariates."
Beer TM, Tangen CM, Bland LB, et al. Prognostic value of anemia in newly diagnosed metastatic prostate cancer: a multivariate analysis of southwest oncology group study 8894. J Urol. 2004;172(6, Part 1 of 2):2213-2217.
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