title: Oral ferrous sulfate does not increase preoperative hemoglobin in patients scheduled for hip or knee arthroplasty.
abstract: BACKGROUND
  Low hemoglobin (Hb) concentrations before lower limb joint replacement are associated with the need for blood transfusions and increased mortality. To optimize preoperative Hb, blood conservation protocols often recommend oral iron supplements, even in nonanemic patients.
  
  
  OBJECTIVE
  To investigate the impact of ferrous sulfate on the change in Hb prior to hip or knee arthroplasty and evaluate the effect of oral iron on hematocrit, mean corpuscular volume (MCV), ferritin, and transferrin saturation, as well as its tolerability and treatment adherence.
  
  
  METHODS
  We conducted a prospective, observational cohort study of adults with Hb concentrations between 10 and 15 g/dL who received iron supplementation prior to hip or knee arthroplasty. Systemic inflammatory diseases, vitamin B(12) or folate deficiency, and current use of iron supplements, intravenous iron, or erythropoietin were exclusion criteria. All participants were prescribed ferrous sulfate 300 mg 3 times daily for a minimum of 3 weeks. Complete blood cell counts and iron studies were performed before therapy and surgery.
  
  
  RESULTS
  Eighty-seven patients with a mean (SD) Hb of 13.47 (0.84) g/dL were included in the study. Preoperative Hb decreased after treatment with iron (-0.14 [0.53] g/dL, p = 0.015). Hematocrit also declined (-0.6% [1.8%], p = 0.002), whereas ferritin increased (25.8 [38.6] ng/mL, p < 0.001). No significant change was seen in MCV and transferrin saturation. The most common adverse effects were constipation (33.3%), heartburn (13.8%), and abdominal pain (12.6%). The adherence rate was 67.1%.
  
  
  CONCLUSIONS
  Oral ferrous sulfate supplementation is not an effective method to increase preoperative Hb in patients scheduled for hip or knee arthroplasty, and its use is associated with adverse effects.
authors.affiliation: University of Montreal, Montreal Heart Institute, Montreal, Quebec, Canada. kim.lachance@icm-mhi.org
authors.forename: Kim
authors.initials: K
authors.lastname: Lachance
authors.forename: Michel
authors.initials: M
authors.lastname: Savoie
authors.forename: Maryse
authors.initials: M
authors.lastname: Bernard
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Rochon
authors.forename: Josée
authors.initials: J
authors.lastname: Fafard
authors.forename: Robert
authors.initials: R
authors.lastname: Robitaille
authors.forename: Pascal-André
authors.initials: PA
authors.lastname: Vendittoli
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lévesque
authors.forename: Simon
authors.initials: S
authors.lastname: de Denus
mesh_terms: D000284:Administration, Oral; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001772:Blood Cell Count; D015331:Cohort Studies; D004909:Erythrocyte Indices / Q000187:drug effects; D005260:Female; D005293:Ferritins / Q000187:drug effects / Q000378:metabolism; D005296:Ferrous Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D006400:Hematocrit / Q000379:methods; D006454:Hemoglobins / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies
chemical_list: D005296:Ferrous Compounds; D006454:Hemoglobins; C020748:ferrous sulfate; D005293:Ferritins