Oral or intravenous iron as an adjuvant to autologous blood donation in elective surgery: a randomized, controlled study

BACKGROUND: This study was performed to evaluate the capacity of oral and i ntravenous (IV) iron administration during autologous blood donation (ABD) to improve the efficacy of ABD and to prevent the need for allogeneic blood transfusion in patients without iron deficiency who are undergoing major e lective surgery for which a minimum of 3 autologous units have been ordered . STUDY DESIGN AND METHODS: One hundred twenty-three patients were enrolled i n an open-labeled, randomized, controlled trial and assigned to three treat ment groups: patients in Group 1 received 3 x 100 mg of Fe2+ per day given orally for 5 weeks before operation; patients in Group 2 received 200 mg of Fe3+ given intravenously after each donation combined with initial IV iron supplementation in patients with hemoglobin under 15 g per dL; and patient s in Group 3 were in the control group that received no iron medication. A modest ABD program involving weekly phlebotomy and threshold hemoglobin val ues for donation of 11.5 g per dL in women and 12.0 g per dL in men was per formed. RESULTS: Ninety patients, 15 women and 15 men in each of the three groups, completed the study. The mean net red cell production during ABD was no hig her (p>0.2) in the iron-treated groups (Group 1:473 +/- 178 mt; Group 2: 43 6 +/- 170 mt; Group 3 (controls): 397 +/- 174 mL). The mean number of autol ogous units donated per patient did not differ (p>0.7) among the groups (Gr oup 1: 3.1 +/- 0.6; Group 2: 2.9 +/- 0.7; Group 3. 3.0 +/- 0.7). The propor tion of patients who needed allogeneic blood transfusion showed no signific ant (p>0.4) advantage for iron treatment, (Group 1: 7%; Group 2: 20%; Group 3: 10%). CONCLUSION: In non-iron-deficient patients undergoing modest ABD without er ythropoietin therapy, neither oral nor IV application of iron during the pr eoperative period enhances the success of preoperative ABD.