Iron Deficiency Anemia
Conditions
Keywords
iron deficiency, liver transplantation, intravenous iron
Brief summary
Transfusion management improvement programs, generally known as patient blood management (PBM) programs, are based on a set of perioperative measures aimed at improving clinical outcomes by avoiding unnecessary exposure to blood components. In a recent series of liver transplants (LT) performed in Spanish centers belonging to the Spanish Liver Transplant Society, despite optimal hemostasis management and preservation of the vena cava, around 20% of patients required massive transfusion (considered as the administration of 6 or more red blood cell concentrates intraoperatively). In addition, 63% of the patients were transfused with at least one packed red cells during the operation. By correcting the iron deficiency in patients who meet the criteria of the anemia study (transferrin saturation less than 20%), we could improve the hemoglobin level, which would allow a wider margin for the transfusion of red cell concentrates.
Detailed description
This is a prospective observational multicenter study to evaluate the efficacy of iron administration in patients candidates to LT. Inclusion criteria Patients with Hb \< 11.5 g/dL + and transferrin saturation index \< 40%+ferritina \<800mcg/L will receive Fe carboxymaltose iv\* \*Ganzoni formula modified (total iron dose = \[actual body weight × (11.5-actual Hb)\] × 2.4 + 500), and represent the intervention group. Those patients with Hb \< 11.5 g/dL and transferrin saturation index \> 40% will constitute the control group. The Intraoperative managed protocol was standardized within groups and Teams. Demographic and liver function test after iron administration will be registered; perioperative transfusion data will be recorded. Recruitment, treatment and follow-up will be conducted by monitored by an independent audit to assure the quality of data. Specific Data Unit not related to the participated Teams will do statistical analysis. The primary outcome is the feasibility of apply the first pillar of the patient blood management programs (PBM) in LT candidates. Secondary outcomes are the response rate (increase in Hb \> 1 g/dL) to the intervention, and red blood cell requirements in both, intervention and control group
Interventions
DRUGintravenous iron
One dose of intravenous iron carboxymaltose calculated according to ganzoni's formula. If after thirty days of the first dose, a second dose of 500mg will be administered if the patient continues to meet the inclusion criteria.
Sponsors
University of Barcelona
Hospital Universitari de Bellvitge
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* liver cirrhosis on the liver transplant waiting list * haemoglobin lower than 11.5g/dL * transferrin saturation index below 40% * ferritin below 800mcg/L
Exclusion criteria
* refusal to participate * Known hypersensitivity to Ferinject * current infection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| degree of implementation of the PBM programme | 30 days after the intervention or pre-surgery | To assess the degree of implementation of the PBM Programme in its first pillar in patients with iron deficiency anaemia, determining the degree and quality of implementation of the PBM programme in liver transplantation, measured as the percentage of patients complying with the iron correction protocol |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Effectiveness | Pre-surgery | Percentage of responding patients, understanding positive response as an increase in haemoglobin ≥ 1 g/dl from inclusion in the study to the day of transplantation. |
| Clinical efficacy | immediately after the surgery | Percentage of patients requiring transfusion and intraoperative massive transfusion and the number of red blood cell concentrates received per patient, compared to a cohort, adjusted for the characteristics of the included population, of patients transplanted in the same period with anaemia of inflammatory cause |
Other
| Measure | Time frame | Description |
|---|---|---|
| security | immediately after the intervention | Safety variables related to iron administration. |
Countries
Spain
Contacts
Primary ContactAntoni Sabate, MD
Backup ContactLourdes LP Perez, MD,PhD
Outcome results
None listed