Intravenous iron supplementation after liver surgery: Impact
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Anemia is a recognized risk factor for perioperative-related morbidity and mortality and is frequently reported in liver surgeries with an estimated incidence of 32%. The study suggests that IV iron supplementation postoperatively prevents functional iron deficiency.

Researchers aim to assess the impact of intravenous iron administration in the immediate postoperative period on anemia and iron status as well as to determine the kinetics of hepcidin after liver surgery.

The HepciFer trial, a randomized controlled trial, included 50 patients undergoing liver surgery. In accordance with the randomization process, patients received either ferric carboxymaltose (15 mg/kg, maximum 1 g) or placebo 4 hours after surgery.

The results:
--The mean hemoglobin level, 7 days after surgery, did not differ significantly between the intervention and control group with a mean difference of +0.7 g/dL.

--Within patients receiving intravenous iron supplementation, none presented biological signs of functional iron deficiency.

--Hepcidin levels remained significantly higher during the observation period in the intervention group.

--Inflammatory biomarkers, red blood cell transfusion rate, and hospital duration of stay were similar between groups.

Overall, intravenous ferric carboxymaltose administration did not result in a significant increase in hemoglobin levels 7 days after surgery. However, this study suggests that intravenous iron supplementation in the immediate postoperative settings prevents functional iron deficiency. Intravenous iron supplementation overcame the hepcidin-mediated blockade of iron absorption and should be considered as the preferred route of administration in the postoperative period.

Surgery
Source: https://doi.org/10.1016/j.surg.2021.03.020
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