Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia

Purpose: To determine if early recovery from severe postoperative anemia is accelerated by iv iron therapy alone or in combination with recombinant erythropoietin (EPO). Methods: In this double-blinded, placebo-controlled randomized study, consenting adult patients without preoperative anemia whose hemoglobin concentration (Hb) was 70 to 90 g(.)L(-1) on the first day after cardiac or orthopedic surgery (POD 1) were assigned to one of three groups: control, iv iron alone (200 mg of iron sucrose on POD 1, 2, and 3) or in combination with EPO (600 U-kg(-1) on POD I and 3). The primary outcome was increase in Hb (adjusted for red blood cell transfusions) from POD 1 to 7. Analysis was by intention-to-treat in patients for whom the primary outcome was available. Group effect was analyzed by the ANOVA test, and between-group differences were specified with a Duncan multiple-range test. Results: The primary outcome was available in 31 of 38 randomized patients. The average POD I Hb was 84 +/- 4 g(.)L(-1). There were no between-group differences in outcomes except for higher reticulocyte counts on POD-7 in the combination group. The average adjusted one-week increases in Hb were 7 +/- 8g(.)L(-1) in the control group (n = 10), 9 +/- 9 g(.)L(-1) in the iv iron group (n = 11), and 10 +/- 14 g(.)L(-1) in the combination group (n = 10). The average adjusted six-week increases in Hb were 37 +/- 14 g(.)L(-1) in the control group, 40 +/- 7 g(.)L(-1) in the iv iron group, and 45 +/- 12 g(.)L(-1) in the combination group. Conclusion: Early postoperative treatment with iv iron alone or in combination with EPO does not appear to accelerate early recovery from postoperative anemia.