IRON SUPPLEMENTATION FOR ACUTE BLOOD-LOSS ANEMIA AFTER CORONARY-ARTERY BYPASS-SURGERY - A RANDOMIZED, PLACEBO-CONTROLLED STUDY

Objective: To evaluate the use of oral iron replacement therapy as an effective treatment for acute surgically induced anemia. Design: Doubl e-blind, placebo-controlled, randomized clinical trial. Setting: Perio perative acute care hospital and a surgery clinic for a single cardiot horacic physician group. Patients: One hundred twenty-eight men and po stmenopausal women, 50 years of age or older, admitted for elective co ronary artery bypass surgery over a consecutive 8-month period. Outcom e Measures: Before surgery: serum iron, serum ferritin, hemoglobin and hematocrit. Six days after surgery: hemoglobin and hematocrit. Mean o f 59 days after surgery: serum iron, serum ferritin, hemoglobin and he matocrit. Intervention: Patients were randomized to one of four groups : control group; placebo group; low-dose group, 50 mg elemental iron 60 mg ascrobic acid in a multi-vitamin daily; and usual-dose group, 2 00 mg elemental iron daily. Results: One hundred twenty-one subjects c ompleted the study: 100 men (82.6%) mean age 64.5 years and 21 women ( 17.4%), mean age 65.7 years. There were no statistically significant a ge or gender differences among groups. Statistical analysis revealed, except for side effects, no differences between or among groups for an y variable measured during the last two time intervals. The mean hemog lobin and hematocrit of the entire sample at 6 days was 9.5 +/- 1.2 gm /dl and 28% +/- 2.3%, respectively. At a mean of 59 days later these v alues increased equally for all groups to a mean for the cohort of 13. 6 +/- 1 gm/dl for hemoglobin and 40.6% +/- 3 for hematocrit. Serum iro n and ferritin were within the normal range. The 200 mg group experien ced significantly more side effects (p < 0.01). Conclusion: Thus the u se of oral iron supplements for the treatment of acute blood loss anem ia after uncomplicated coronary artery bypass surgery did not assist i n restoring red blood cell mass or help maintain total body iron store s.