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Use of intravenous iron therapy in colorectal cancer patient with iron deficiency anemia: a propensity-score matched study

Abstract

Purpose

Iron deficiency anemia is common in colorectal cancer patients and is related to poor surgical outcome. Increasing evidence supports preoperative use of intravenous iron (IVI) to correct anemia. Our study investigates effect of preoperative IVI on hemoglobin level.

Methods

From August 2017 to March 2019, colorectal cancer patients with iron deficiency anemia received intravenous iron at least 2 weeks before their scheduled operations (IVI group). These patients’ prospectively collected data were compared to a historic cohort of anemic patients who received elective colorectal surgery within 3 years before the study period (non-IVI).

Results

Forty-six patients were included after receiving intravenous iron. After propensity score matching on 1:2 ratio, 38 patients in IVI group were matched with 62 patients from non-IVI group. There was no statistical difference for preoperative mean hemoglobin level between the two groups (8.43 g/dL in IVI, 8.79 g/dL in non-IVI, p = 0.117), but IVI group has significantly higher mean hemoglobin level on admission (10.63 g/dL in IVI, 9.46 g/dL in non-IVI, p = < 0.001). IVI group had higher median hemoglobin rise (1.9 in IVI, 0.6 in non-IVI, p = <0.001) and significantly less red cell transfusion (8 patients in IVI, 30 in non-IVI, p = 0.006). Subgroup analysis showed that less patients in IVI group required transfusions in preoperative period (1 in IVI group, 20 in non-IVI, p < 0.001).

Conclusion

Our data suggested that IVI can significantly increase hemoglobin level in iron deficiency anemic patients before colorectal surgery, with reduction in red cell transfusions.

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References

  1. 1.

    Muñoz M, Laso-Morales MJ, Gómez-Ramírez S, Cadellas M, Núñez-Matas MJ, García-Erce JA (2017) Pre-operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery. Anaesthesia. 72(7):826–834. https://doi.org/10.1111/anae.13840

  2. 2.

    Ludwig H, Van Belle S, Barrett-Lee P, Birgegård G, Bokemeyer C, Gascón P et al (2004) The European Cancer Anaemia survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer 40(15):2293–2306. https://doi.org/10.1016/j.ejca.2004.06.019

  3. 3.

    Wilson MJ, Dekker JWT, Harlaar JJ, Jeekel J, Schipperus M, Zwaginga JJ (2017) The role of preoperative iron deficiency in colorectal cancer patients: prevalence and treatment. Int J Color Dis 32(11):1617–1624. https://doi.org/10.1007/s00384-017-2898-1

  4. 4.

    Muñoz M, Gómez-Ramírez S, Campos A, Ruiz J, Liumbruno GM (2015) Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus 13(3):370–379. https://doi.org/10.2450/2015.0014-15

  5. 5.

    Dunne JR, Malone D, Tracy JK, Gannon C, Napolitano LM (2002) Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. J Surg Res 102(2):237–244. https://doi.org/10.1006/jsre.2001.6330

  6. 6.

    Egenvall M, Mörner M, Martling A, Gunnarsson U (2018) Prediction of outcome after curative surgery for colorectal cancer: preoperative haemoglobin, C-reactive protein and albumin. Color Dis 20(1):26–34. https://doi.org/10.1111/codi.13807

  7. 7.

    Tokunaga R, Nakagawa S, Miyamoto Y, Ohuchi M, Izumi D, Kosumi K, Taki K, Higashi T, Miyata T, Yoshida N, Baba H (2019) The impact of preoperative anaemia and anaemic subtype on patient outcome in colorectal cancer. Color Dis 21(1):100–109. https://doi.org/10.1111/codi.14425

  8. 8.

    Keeler BD, Simpson JA, Ng S, Tselepis C, Iqbal T, Brookes MJ, Acheson AG (2014) The feasibility and clinical efficacy of intravenous iron administration for preoperative anaemia in patients with colorectal cancer. Color Dis 16(10):794–800. https://doi.org/10.1111/codi.12683

  9. 9.

    Laso-Morales M, Jericó C, Gómez-Ramírez S, Castellví J, Viso L, Roig-Martínez I et al (2017) Preoperative management of colorectal cancer-induced iron deficiency anemia in clinical practice: data from a large observational cohort: PREOPERATIVE ANEMIA MANAGEMENT IN CRC. Transfusion 57(12):3040–3048. https://doi.org/10.1111/trf.14278

  10. 10.

    Wilson MJ, Dekker JW, Bruns E, Borstlap W, Jeekel J, Zwaginga JJ et al (2018) Short-term effect of preoperative intravenous iron therapy in colorectal cancer patients with anemia: results of a cohort study: IV IRON IN COLORECTAL CANCER PATIENTS. Transfusion 58(3):795–803. https://doi.org/10.1111/trf.14456

  11. 11.

    Keeler BD, Simpson JA, Ng O, Padmanabhan H, Brookes MJ, Acheson AG et al (2017) Randomized clinical trial of preoperative oral versus intravenous iron in anaemic patients with colorectal cancer. Br J Surg 104(3):214–221. https://doi.org/10.1002/bjs.10328

  12. 12.

    Quinn EM, Meland E, McGinn S, Anderson JH (2017) Correction of iron-deficiency anaemia in colorectal surgery reduces perioperative transfusion rates: a before and after study. Int J Surg 38:1–8. https://doi.org/10.1016/j.ijsu.2016.12.029

  13. 13.

    Wilson MJ, Dekker JWT, Buettner S, Harlaar JJ, Jeekel J, Schipperus M, Zwaginga JJ (2018) The effect of intravenous iron therapy on long-term survival in anaemic colorectal cancer patients: results from a matched cohort study. Surg Oncol 27(2):192–199. https://doi.org/10.1016/j.suronc.2018.03.005

  14. 14.

    Ng O, Keeler BD, Mishra A, Simpson A, Neal K, Brookes MJ et al (2015) Iron therapy for pre-operative anaemia. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011588.pub2

  15. 15.

    Hallet J, Hanif A, Callum J, Pronina I, Wallace D, Yohanathan L et al (2014) The impact of perioperative Iron on the use of red blood cell transfusions in gastrointestinal surgery: a systematic review and meta-analysis. Transfus Med Rev 28(4):205–211. https://doi.org/10.1016/j.tmrv.2014.05.004

  16. 16.

    Calleja JL, Delgado S, del Val A, Hervás A, Larraona JL, Terán Á et al (2016) Ferric carboxymaltose reduces transfusions and hospital stay in patients with colon cancer and anemia. Int J Color Dis 31(3):543–551. https://doi.org/10.1007/s00384-015-2461-x

  17. 17.

    Muñoz M, Acheson AG, Auerbach M, Besser M, Habler O, Kehlet H et al (2017) International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 72(2):233–247. https://doi.org/10.1111/anae.13773

  18. 18.

    Avni T, Bieber A, Grossman A, Green H, Leibovici L, Gafter-Gvili A (2015) The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clin Proc 90(1):12–23. https://doi.org/10.1016/j.mayocp.2014.10.007

  19. 19.

    Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmén J (2006) Update on adverse drug events associated with parenteral iron. Nephrol Dial Transplant 21(2):378–382. https://doi.org/10.1093/ndt/gfi253

  20. 20.

    Ng O (2016) Iron, microbiota and colorectal cancer. Wien Med Wochenschr 166(13–14):431–436. https://doi.org/10.1007/s10354-016-0508-4

  21. 21.

    Wilson MJ, Harlaar JJ, Jeekel J, Schipperus M, Zwaginga JJ (2018) Iron therapy as treatment of anemia: a potentially detrimental and hazardous strategy in colorectal cancer patients. Med Hypotheses 110:110–113. https://doi.org/10.1016/j.mehy.2017.12.011

  22. 22.

    Wilson MJ, van Haaren M, Harlaar JJ, Park HC, Bonjer HJ, Jeekel J et al (2017) Long-term prognostic value of preoperative anemia in patients with colorectal cancer: a systematic review and meta-analysis. Surg Oncol 26(1):96–104. https://doi.org/10.1016/j.suronc.2017.01.005

  23. 23.

    Kwon HY, Kim BR, Kim YW (2019) Association of preoperative anemia and perioperative allogenic red blood cell transfusion with oncologic outcomes in patients with nonmetastatic colorectal cancer. Curr Oncol 26(3):e357–e366. https://doi.org/10.3747/co.26.4983

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Correspondence to Philip Ming-Ho Kam.

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Kam, P.M., Chu, C.W., Chan, E.M. et al. Use of intravenous iron therapy in colorectal cancer patient with iron deficiency anemia: a propensity-score matched study. Int J Colorectal Dis (2020). https://doi.org/10.1007/s00384-020-03508-y

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Keywords

  • Colorectal cancer
  • Iron deficiency anemia
  • Intravenous iron
  • Red cell transfusion