By Ed Susman
ORLANDO, Fla -- January 25, 2010 -- Patients who undergo surgery for colorectal cancer and receive intravenous iron to correct low haemoglobin levels rather than packed red blood cells appear to have a significantly reduced hospital length of stay, researchers said here at the 2010 Gastrointestinal Cancers Symposium (ASCO-GI).
"We believe our proactive use of intravenous iron in the correction of iron deficiency is assisting in slowing of the progression of anaemia and therefore the need for blood," said Kirby Sweitzer, MD, Mercy Medical Center, Canton, Ohio, on January 24.
Dr. Sweitzer and colleagues reviewed outcomes among 43 patients who were undergoing colorectal cancer surgery at his hospital as part of a blood management intervention that has been in place since April 2002 to prevent the need for transfusion. Of those patients, 31 did not need a blood transfusion while 12 of the patients required packed red cell infusions.
Of those who received only low molecular weight intravenous iron dextran or iron sucrose, the hospital length of stay averaged 8.48 days compared with 16 days for patients who also required blood transfusions (P = .007).
He said the patient haemoglobin at the time of admission appeared to be the best predictor of whether transfusion would be required for treatment. The patients who did not require transfusions had an admitting haemoglobin level of 11.68 g/dL compared with an admission haemoglobin level of 9.68 g/dL for the patients who eventually required blood transfusions (P = .005).
In addition, the nadir haemoglobin also appeared predictive of the need for transfusion. Those who avoided transfusion by the administration of intravenous iron had a lowest haemoglobin level of 9.30 g/dL while the lowest haemoglobin level for those requiring transfusion was 7.83 g/dL (P = .005). The patients who received transfusions had an average of 2.75 units transfused.
Dr. Sweitzer reported 1 serious reaction to intravenous iron infusion in a patient with metastatic colorectal cancer. During his last infusion his nurse reported that the patient had no blood pressure or pulse. The infusion was stopped, oxygen was administered, and the patient regained consciousness and was discharged an hour later.
"This is the only serious adverse reaction we have seen in more than 10 years of giving low molecular weight intravenous iron in over 1,000 doses," he said.
The study received funding from Watson Laboratories, Inc.
The 2010 Gastrointestinal Cancers Symposium is sponsored by the American Gastroenterological Association Institute, the American Society of Clinical Oncology, the American Society for Therapeutic Radiation Oncology, and the Society of Surgical Oncology.
[Presentation title: Decreasing Length of Stay in Colorectal Cancer Surgery Patients With the Proactive Use of Low Molecular Weight IV Iron Dextran Therapy. Abstract 325]
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