Shin Kyun-Ho, Park Jong-Hoon, Jang Ki-Mo, Hong Seok-Ha, Han Seung-Beom
Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea.
Arthroplasty. 2020 Aug 3;2(1):22. doi: 10.1186/s42836-020-00041-9.
Unnecessary costs and complications can be reduced by increasing hemoglobin (Hb) levels and minimizing blood transfusions in patients who underwent total knee arthroplasty (TKA). This study aimed to determine the effects of intravenous iron monotherapy before TKA on preoperative iron deficient anemia and postoperative transfusion rates.
This prospective cohort study included 45 patients scheduled for TKA in the experimental group (Group I) and 221 patients who underwent TKA in 2015 and 2018 in the control group (Group C). One thousand milligrams of ferric carboxymaltose was administrated 1 month before TKA in group I. Intergroup comparison of the rate and total volume of transfusion, perioperative changes in Hb and analysis of iron metabolism variables in group I were performed. Subgroup analysis of Group I was conducted according to the response to iron monotherapy.
Although Hb levels increased after intravenous iron monotherapy in Group I, postoperative transfusion rates in Groups I and C were 17.8% and 18.6%, respectively, without significant intergroup differences in the rate and total units of transfusion. Ferritin level and transferrin saturation were corrected in both subgroups of Group I. Only 17 patients (37.78%) showed response to iron monotherapy, with an Hb increase of 1.0 g/dL or more. Subgroup analysis showed lower proportions of coexisting chronic diseases, including chronic kidney disease in responders.
IV iron monotherapy was shown to be insufficient in successfully treating preoperative iron-deficient anemia to reduce postoperative allogenic blood transfusion in patients who underwent TKA. As preoperative anemia should be managed due to the high rates of postoperative transfusion for this surgery, clinicians should consider the complex interplay among the causal factors of anemia, apart from ID, in patients with preoperative anemia who are scheduled for TKA.
通过提高血红蛋白（Hb）水平并尽量减少全膝关节置换术（TKA）患者的输血，可以降低不必要的成本和并发症。本研究旨在确定TKA术前静脉注射铁剂单一疗法对术前缺铁性贫血和术后输血率的影响。
这项前瞻性队列研究包括实验组（I组）计划进行TKA的45例患者和2015年及2018年进行TKA的对照组（C组）的221例患者。I组在TKA前1个月给予1000毫克羧基麦芽糖铁。对I组输血率和总量进行组间比较，分析Hb围手术期变化及铁代谢变量。根据对铁剂单一疗法的反应对I组进行亚组分析。
虽然I组静脉注射铁剂单一疗法后Hb水平升高，但I组和C组术后输血率分别为17.8%和18.6%，输血率和总输血量组间无显著差异。I组两个亚组的铁蛋白水平和转铁蛋白饱和度均得到纠正。只有17例患者（37.78%）对铁剂单一疗法有反应，Hb升高1.0g/dL或更多。亚组分析显示，反应者中包括慢性肾病在内的共存慢性病比例较低。
静脉注射铁剂单一疗法在成功治疗术前缺铁性贫血以减少TKA患者术后异体输血方面显示不足。由于该手术术后输血率高，术前贫血应得到处理，临床医生应考虑除缺铁外，计划进行TKA的术前贫血患者贫血病因之间的复杂相互作用。
