Solis J V, Portero J L, Diaz J, Garcia R, Ligero J M, Vazquez E, Lodeiro C, Ballesteros L
Angiology and Vascular Surgery Department, Hospital General Universitario "Gregorio Marañón," Madrid, Spain.
Vasc Endovascular Surg. 2006 Oct-Nov;40(5):392-8. doi: 10.1177/1538574406293749.
The objective of this study was to quantify the magnitude of iron deficiency in the postoperative period after open aortic surgery. This was a prospective observational study in 55 consecutive patients. Blood samples were obtained on postoperative days 1, 2, 4, 30, and 45, and the parameters determined were the following: iron, transferrin, transferrin saturation index, transferrin-soluble receptor, ferritin, red cell count, hemoglobin, hematocrit, serum C-reactive protein, fibrinogen, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and number of blood units transfused. We performed statistical ANOVA test for repetitive measurements (lower bound) in regard to its basal level. Iron deficiency and its parameters reached the maximum at 48 hours postoperatively (iron: 18.92 g/dL and transferrin saturation index: 11.1%) (P <.05). There was not a complete recovery after 45 days (iron: 51.23 g/dL and transferrin saturation index: 18.0%) (P <.05). A similar evolution was observed in the other measured parameters (red cell count: 3.5 x 106/L.; hemoglobin: 10.4 g/dL; hematocrit: 30.7%) (P <.005), none affecting the values of concentration or volume (P <.05). Transferrin-soluble receptors, normal at first, were increased at postoperative days 30 and 45 (2.7 and 2.4 mg/dL respectively, P <.005). After open aortic surgery there is an important acute-phase reaction, a dramatic iron deficiency, and a lack of its transporters until the 45th analyzed day. The elevation of transferrin-soluble receptors in the 4th and 6th weeks denotes a necessity of iron supplementation for a correct development of the immature hematic cells since blood parameters do not reach normal levels in the 6th postoperative week.
本研究的目的是量化开放性主动脉手术后围手术期缺铁的程度。这是一项对55例连续患者进行的前瞻性观察研究。在术后第1、2、4、30和45天采集血样，测定的参数如下：铁、转铁蛋白、转铁蛋白饱和度指数、转铁蛋白可溶性受体、铁蛋白、红细胞计数、血红蛋白、血细胞比容、血清C反应蛋白、纤维蛋白原、平均红细胞体积、平均红细胞血红蛋白、平均红细胞血红蛋白浓度以及输注的血单位数量。我们针对其基础水平进行了重复测量（下限）的统计方差分析测试。缺铁及其参数在术后48小时达到最大值（铁：18.92 g/dL，转铁蛋白饱和度指数：11.1%）（P<.05）。45天后未完全恢复（铁：51.23 g/dL，转铁蛋白饱和度指数：18.0%）（P<.05）。在其他测量参数中观察到类似的变化（红细胞计数：3.5×10⁶/L；血红蛋白：10.4 g/dL；血细胞比容：30.7%）（P<.005），均未影响浓度或体积值（P<.05）。起初正常的转铁蛋白可溶性受体在术后第30天和第45天升高（分别为2.7和2.4 mg/dL，P<.005）。开放性主动脉手术后存在重要的急性期反应、严重的缺铁以及在分析的第45天之前缺乏铁转运蛋白。第4周和第6周转铁蛋白可溶性受体的升高表明，由于术后第6周血液参数未达到正常水平，为未成熟血细胞的正常发育补充铁是必要的。
