Lidder P G, Sanders G, Whitehead E, Douie W J, Mellor N, Lewis S J, Hosie K B
Department of Colorectal Surgery, Derriford Hospital, Plymouth, UK.
Ann R Coll Surg Engl. 2007 May;89(4):418-21. doi: 10.1308/003588407X183364.
Allogeneic blood transfusion confers a risk to the recipient. Recent trials in colorectal surgery have shown that the most significant factors predicting blood transfusion are pre-operative haemoglobin, operative blood loss and presence of a transfusion protocol. We report a randomised, controlled trial of oral ferrous sulphate 200 mg TDS for 2 weeks' pre-operatively versus no iron therapy.
Patients diagnosed with colorectal cancer were recruited from out-patient clinic and haematological parameters assessed. Randomisation was co-ordinated via a telephone randomisation centre.
Of the 49 patients recruited, 45 underwent colorectal resection. There were no differences between those patients not receiving iron (n = 23) and the iron-supplemented group (n = 22) for haemoglobin at recruitment, operative blood loss, operation duration or length of hospital stay. At admission to hospital, the iron-supplemented group had a higher haemoglobin than the non-iron treated group (mean haemoglobin concentration 13.1 g/dl [range, 9.6-17 g/dl] versus 11.8 g/dl [range, 7.8-14.7 g/dl]; P = 0.040; 95% CI 0.26-0.97) and were less likely to require operative blood transfusion (mean 0 U [range, 0-4 U] versus 2 U [range, 0-11 U] transfused; P = 0.031; 95% CI 0.13-2.59). This represented a cost reduction of 66% (47 U of blood = pound4700 versus oral FeSO(4) at pound30 + 15 U blood at pound1500). At admission, ferritin in the iron-treated group had risen significantly from 40 microg/l (range, 15-222 microg/l) to 73 microg/l (range, 27-386 microg/l; P = 0.0036; 95% CI 46.53-10.57).
Oral ferrous sulphate given pre-operatively in patients undergoing colorectal surgery offers a simple, inexpensive method of reducing blood transfusions.
异体输血会给受血者带来风险。近期在结直肠手术方面的试验表明，预测输血的最重要因素是术前血红蛋白水平、术中失血量以及是否存在输血方案。我们报告了一项随机对照试验，比较术前两周每日三次口服200毫克硫酸亚铁与不进行铁剂治疗的效果。
从门诊招募被诊断为结直肠癌的患者，并评估血液学参数。通过电话随机分组中心进行随机分组。
在招募的49例患者中，45例行结直肠切除术。未接受铁剂治疗的患者（n = 23）与补充铁剂的组（n = 22）在招募时的血红蛋白水平、术中失血量、手术时长或住院时间方面无差异。入院时，补充铁剂组的血红蛋白水平高于未接受铁剂治疗组（平均血红蛋白浓度13.1克/分升[范围9.6 - 17克/分升]对11.8克/分升[范围7.8 - 14.7克/分升]；P = 0.040；95%可信区间0.26 - 0.97），且需要术中输血的可能性较小（平均输血量0单位[范围0 - 4单位]对2单位[范围0 - 11单位]；P = 0.031；95%可信区间0.13 - 2.59）。这意味着成本降低了66%（47单位血液 = 4700英镑，而口服硫酸亚铁30英镑 + 15单位血液1500英镑）。入院时，接受铁剂治疗组的铁蛋白水平从40微克/升（范围15 - 222微克/升）显著升至73微克/升（范围27 - 386微克/升；P = 0.0036；95%可信区间46.53 - 10.57）。
对于接受结直肠手术的患者，术前口服硫酸亚铁提供了一种简单、廉价的减少输血的方法。
