In a comprehensive study of medical records involving tens of thousands of patients, researchers have determined that certain individuals with anemia prior to surgery experience better results when treated with iron infusions instead of traditional red blood cell transfusions.
In a comprehensive study of medical records involving tens of thousands of patients, researchers have determined that certain individuals with anemia prior to surgical procedures experience better outcomes when treated with iron infusions rather than conventional red blood cell transfusions.
The study, published on July 22 in Anesthesia & Analgesia, adds to the growing evidence that iron infusions, which enhance the body’s own production of red blood cells, are superior to depending on donor blood.
“Anemia is very common, especially in patients undergoing surgery, and until recently, the go-to treatment has been blood transfusions before surgery,” explains Steven Frank, M.D., a professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine. “However, our retrospective study demonstrated the advantages of iron infusions over preoperative blood transfusions in reducing morbidity and mortality while increasing hemoglobin levels and decreasing the need for additional blood transfusions.”
Iron is an essential mineral for the body, required for the creation of hemoglobin—a protein in red blood cells that transports oxygen to various organs. When there is a deficiency of iron, it leads to anemia, causing a shortage of healthy red blood cells that can adequately deliver oxygen. This is particularly critical for surgery patients, as there is typically some blood loss during any surgical procedure.
While blood transfusions are effective, they also come with risks, such as the potential for blood clots, hospital-acquired infections, allergic reactions, and lung complications. Moreover, it can sometimes be challenging to find a compatible donor if a patient has specific antibodies or conditions like sickle cell disease. Consequently, doctors have long sought ways to minimize the need for transfusions.
In this latest study, the Johns Hopkins Medicine research team utilized data from the TriNetX Research Network, a global collaboration of healthcare organizations that aggregate de-identified patient data. The analysis included information from 2003 to 2023 involving 154,358 patients aged 18 and older diagnosed with iron-deficient anemia before surgery.
The researchers categorized patients into two groups: those receiving iron treatments before surgery without a blood transfusion, and those who underwent a blood transfusion without receiving iron infusions. These iron treatments occurred weeks ahead of the planned surgical intervention. The team then compared rates of postoperative complications, including respiratory issues, kidney problems, blood clots, infections, and mortality rates.
The analysis revealed a 37% decrease in mortality rates and a 24% decrease in morbidity (complications) among patients treated with iron infusions compared to those who received blood transfusions. This suggests that patients treated with iron infusions are likely to experience a quicker and more complete recovery from surgery without the complications that can be associated with blood transfusions.
“In 2012, The Joint Commission and the American Medical Association identified blood transfusions as the most overused medical procedure. For context, antibiotic use for treating common colds was also included on that list,” says Frank. “Research indicates that reducing blood transfusions leads to better patient outcomes, and offering preoperative iron infusions is a straightforward approach to achieve this.”
The study’s authors express hope that their findings will promote broader implementation of preoperative iron infusions for surgical patients. They also plan to investigate whether oral iron supplements provide similar benefits as infusions.
Addressing preoperative anemia is one of several strategies within a comprehensive patient blood management program. Such programs, like the one at Johns Hopkins, can conserve blood and reduce costs while achieving equivalent or improved patient outcomes. In a recent study, researchers noted a significant return on investment for their blood management initiative, indicating savings or revenue of $7.50 for every dollar spent to support it.
Simple interventions, such as ensuring patients stay warm and managing blood pressure during surgery, in addition to administering medications like tranexamic acid, can help minimize bleeding. “Along with treating preoperative anemia,” Frank states, “preserving the patient’s own blood during surgery is a primary goal of any blood management program.” These programs enhance care quality by reducing unnecessary transfusions and improving outcomes while lowering expenses.
Additional contributors to this research include Una Choi, Ryan Nicholson, Ananda Thomas, Elizabeth Crowe, John Ulatowski, Linda Resar, and Nadia Hensley from Johns Hopkins University School of Medicine. Hensley serves on the scientific advisory board of Octapharma and receives author royalties from Wolters Kluwer for contributions to uptodate.com. Frank is on the scientific advisory board for Haemonetics. The other authors report no conflicts of interest.
