To Evaluate the Efficacy of Intravenous Iron Therapy in Optimizing Anemia in Colorectal Cancer Patients and Closed Loop Audit of this Pilot Programme

Background: Treatment of preoperative anemia is recommended aiming to minimize perioperative allogenic red blood cell transfusion. This study aims to analyses and evaluate the efficacy of administration Intravenous iron infusion (IV Iron) in preoperative optimization of anemic patients with colorectal cancer in a Pilot Programme. A close loop Audit of the programme is also conducted.

Methods: A Multidisciplinary Team was formed. Colorectal cancer patients with anemia and met the inclusion criteria were included. IV Iron was given at least 4 weeks before operation. Hemoglobin (Hb) and iron profile were collected as baseline, preoperation, postop Day 1, before discharge and 26 weeks after IV Iron give. Primary Outcome was need for blood transfusion, change in Hb and Fe profile level. Secondary Outcome was 2 Audit Cycles of this programme, postoperative morbidity, 30 Days mortality, hospital stay, safety profile and change in Hb level and anemic symptom 26 weeks after IV Iron. 

Results: 214 patients were included with 183 patients proceeded to operation (1 Jan 2017-1 Feb 2021). 3.27%, 4.92% and 3.27% required preop, intraop and postoperation blood transfusion respectively. 94.9% had raised in Hb, the median increase in Hb was 2.35 g/dL. There was also raised in Fe and ferritin of 3 and 332 respectively. This showed that IV Iron had the effect of reduction of preoperative blood transfusion from 20% to 3.27% (when compared with our retrospective review of cases 2014-16). When compared with pre IV Iron Hb, there was an increase in 4 g/dL in Hb 26 weeks after IV Iron. The percentage of patients with anemic symptom also dropped from 55.1% to 0%.

2 Audit cycles were conducted with improvement in recruitment rate from 49% to 100% and compliance rate.

Conclusion: Our data demonstrates that preoperative IV Iron can help reduction of blood transfusion preoperatively. It can also raise the Hb and Iron profile. It also demonstrates the sustainability in terms of Hb level and improvement in anemic symptom. A close loop audit also demonstrates the feasibility of implementing this programme in optimizing anemia in colorectal cancer patients.

Author(s): Siu Yan Kok, Chui Ping Florey LAM and Pui Yin Tracy Tang

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