title: The feasibility and clinical efficacy of intravenous iron administration for preoperative anaemia in patients with colorectal cancer.
abstract: OBJECTIVE
  The study aimed to analyse the feasibility and efficacy of administration of a single intravenous iron infusion (IVI) in the preoperative optimization of colorectal cancer patients with anaemia.
  
  
  METHODS
  Twenty patients were recruited at least 14 days before the planned date of surgery. A single 1000 mg dose of ferric carboxymaltose (Ferinject) was administered as an outpatient procedure. Blood samples were taken at recruitment prior to drug administration (REC), on the day of surgery prior to any intervention (DOS) and on the first postoperative day. Allogeneic red blood cell transfusions (ARBT) and outcomes were recorded from recruitment throughout the study period.
  
  
  RESULTS
  There was a significant median rise in haemoglobin levels (Hb) from REC to DOS of 1.8 g/dl [interquartile range (IQR) 0.75-2.45, P < 0.001] for the entire cohort. Two patients received ARBT preoperatively, and for those not transfused preoperatively (n = 18), this incremental Hb rise remained significant (P < 0.001, median 1.65 g/dl, IQR 0.5-2.3). Of these patients, those who responded to IVI had higher erythropoietin (EPO) levels at recruitment (P < 0.01) and lower recruitment Hb values, transferrin-saturation (TSAT) and C-reactive protein (CRP) levels (P < 0.05). REC Hb (Rs = -0.62, P < 0.01), REC TSAT levels (Rs = -0.67, P < 0.01) and REC EPO (Rs = 0.69, P < 0.01) correlated with the magnitude of treatment change in Hb levels. Five patients received ARBT until the fourth postoperative day, which was significantly fewer than predicted (P < 0.05).
  
  
  CONCLUSIONS
  IVI can be administered preoperatively in the outpatient clinic to colorectal cancer patients with anaemia, with associated reduction in ARBT use and increase in Hb levels.
authors.affiliation: Division of GI Surgery, University of Nottingham, Nottingham, UK; Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: B D
authors.initials: BD
authors.lastname: Keeler
authors.forename: J A
authors.initials: JA
authors.lastname: Simpson
authors.forename: S
authors.initials: S
authors.lastname: Ng
authors.forename: C
authors.initials: C
authors.lastname: Tselepis
authors.forename: T
authors.initials: T
authors.lastname: Iqbal
authors.forename: M J
authors.initials: MJ
authors.lastname: Brookes
authors.forename: A G
authors.initials: AG
authors.lastname: Acheson
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008320:Maltose / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D011300:Preoperative Care; D061250:Transferrins / Q000097:blood
chemical_list: D005290:Ferric Compounds; D006454:Hemoglobins; D061250:Transferrins; D004921:Erythropoietin; C522335:ferric carboxymaltose; D008320:Maltose; D002097:C-Reactive Protein
keywords: Surgery; cancer; other