Situation

Iron deficiency is the most prevalent nutritional deficiency and commonest cause of anaemia. The incidence of anaemia varies with patient age, gender and surgical presentation.

Anaemia is linked to worse surgical outcomes and in turn red cell transfusion is associated with morbidity and increased length of stay. Preoperative haemoglobin optimisation is a physiologically plausible and potentially beneficial means to minimise this potential harm.

Previously intravenous iron was increasingly suggested as the iron therapy of choice – eliminating the concerns of compliance, poor absorption and raised Hepcidin levels that limit the efficacy of oral iron.

The PREVENTT trial is a recently published large RCT of the preoperative use of IV Ferinject in patients undergoing major upper GI, lower GI, Gynaecology or Urology surgery¹. No benefit was demonstrated for the primary endpoints of transfusion rate or mortality.

It is necessary to consider how this impacts on existing preoperative anaemia optimisation policies.