Guinea J M, Lafuente P, Mendizábal A, Pereda A, Sainz Arroniz M R, Pérez Clausell C
Servicio de Hematología, Hospital de Txagorritxu, Vitoria.
Sangre (Barc). 1996 Feb;41(1):25-8.
Restrictive erythropoiesis caused by iron deficiency may hinder pre-deposit autotransfusion in surgical procedures. In order to evaluate the response to prophylactic ferrous ascorbate, a prospective study was conducted on patients subjected to orthopaedic surgery and autotransfusion.
Sixty-eight patients were included in the study: hip prostheses 67%, knee prostheses 25%, other procedures 7.4%. Their mean age was 61.3 +/- 10.2 years, and there were 42% male and 57% female. A mean of 2.8 +/- 0.6 units (450 mL) of blood were drawn to each patient in a month. Starting one week before their first blood donation and up to 2 months after surgery, each patient received 99 mg elementary iron per days as oral ferrous ascorbate. Blood cell counts were done at the beginning of the programme and after the first, second, third and fourth blood withdrawal, as well as one month after finishing the treatment. A survey of iron profile including serum iron, total iron binding capacity, transferrin saturation, serum ferritin and free erythrocyte protoporphyrin was carried out at onset and end of the programme in each patient. All data were analysed with the SPSS-PC 4.0 statistical programme.
Haemoglobin rates decreased in every control, returning to values close to the initial ones by the end of the programme (mean figures are as follows: 14.63; 13.17; 12.70; 11.88; 14.11 g/dL); and similar changes were seen with respect to the other parameters of blood. The initial and final values for ferritin were 157.32 and 91.06 ng/mL, respectively, and no significant changes were appreciated in the other data from the iron profile, regardless of the number of blood units collected in a given case. Minor intolerance to ferrous ascorbate appeared in 11% of the patients. No significant differences with control patients were seen regarding hospitalization (16.54 vs 19.82 days) or postoperative fever (14.1% vs 17.11%).
As opposed to others, we feel that iron treatment should be maintained up to 2 months after surgery since better results are thus attained. Recombinant erythropoietin is more expensive a method. Ferrous ascorbate is better tolerated than ferrous sulphate plus additives.
缺铁引起的限制性红细胞生成可能会妨碍外科手术中的预存式自体输血。为了评估预防性使用抗坏血酸亚铁的效果，我们对接受骨科手术和自体输血的患者进行了一项前瞻性研究。
68例患者纳入研究：髋关节置换术患者占67%，膝关节置换术患者占25%，其他手术患者占7.4%。他们的平均年龄为61.3±10.2岁，男性占42%，女性占57%。每个患者在一个月内平均采集2.8±0.6单位（450毫升）血液。从首次献血前一周开始直至术后2个月，每位患者每天口服99毫克元素铁的抗坏血酸亚铁。在项目开始时、首次、第二次、第三次和第四次采血后以及治疗结束后1个月进行血细胞计数。在每个患者项目开始时和结束时进行铁指标检测，包括血清铁、总铁结合力、转铁蛋白饱和度、血清铁蛋白和游离红细胞原卟啉。所有数据采用SPSS-PC 4.0统计程序进行分析。
每次检查时血红蛋白率均下降，到项目结束时恢复到接近初始值（平均数值如下：14.63；13.17；12.70；11.88；14.11克/分升）；血液的其他参数也出现类似变化。铁蛋白的初始值和最终值分别为157.32和91.06纳克/毫升，无论某一病例采集的血液单位数量如何，铁指标的其他数据均未出现显著变化。11%的患者出现对抗坏血酸亚铁的轻微不耐受。在住院时间（16.54天对19.82天）或术后发热情况（14.1%对17.11%）方面，与对照患者相比无显著差异。
与其他观点不同，我们认为术后应持续进行2个月的铁剂治疗，因为这样能取得更好的效果。重组促红细胞生成素方法更为昂贵。抗坏血酸亚铁的耐受性优于硫酸亚铁加添加剂。
