Post-operative anaemia in femoral neck fracture patients: Does it need treatment? A single blinded prospective randomised controlled trial.

Prasad N, Rajamani V, Hullin D, Murray JM
Injury 2009;40:1073-1076.
NATA Rating :
Review by : M. Muoz
NATA Review

In this single-blind randomized study, oral iron for 4 weeks (3×200 mg/day; n=32) resulted in significantly increased Hb levels on postoperative day 30 (+0.76 g/dL) when compared with no treatment (n=34) and there were no major complications. However, the authors excluded patients with preexisting anemia, inflammatory or bleeding conditions, and those with absolute or functional iron deficiency (low ferritin or normal ferritin with high CRP).

These data are in disagreement with those previously published (Zauber NP et al., JAMA 1992;267:525-527). The impact of increased Hb on functional outcome (e.g., quality of life) was not assessed (Conlon NP et al., Anesth Analg 2008;106:1056-1061). All these limit the applicability of study results and make unclear the meaning of the authors’ final statement, “we recommend oral iron supplementation in elderly anaemic patients with hip fracture in the postoperative period”.

In addition, the authors do not mention either the different studies with IV iron (with or without EPO) (Garca-Erce JA et al. Vox Sanguinis 2005; 88: 235-243; Garca-Erce JA et al. Vox Sanguinis 2009; in press) in this patient population or the recently published consensus statement on IV iron in surgery (Beris P et al., Br J Anaesth 2008;100:599-604).

– Manuel Muoz