The effect of intravenous iron on erythropoiesis in older people with hip fracture

Moppett, I.K.; Rowlands, M.; Mannings, A.M.; Marufu, T.C.; Sahota, O.; Yeung, J.

Abstract

Background: Anaemia following hip fracture is common and associated with worse outcomes. Intravenous iron is a potential non-transfusion treatment for this anaemia and has been found to reduce transfusion rates in previous observational studies. There is good evidence for its use in elective surgical populations.

Objective: to examine the impact of intravenous iron on erythropoiesis following hip fracture. Design: two-centre, assessor-blinded, randomised, controlled trial of patients with primary hip fracture and no contra-indications to intravenous iron.

Method: The intervention group received three doses of 200mg iron sucrose over 30 minutes (Venofer, Vifor Pharma, Bagshot Park, UK) on three separate days. Primary outcome was reticulocyte count at day 7 after randomisation. Secondary outcomes included haemoglobin concentration, complications and discharge destination. Eighty participants were randomised.

Results: There was a statistically significantly greater absolute final reticulocyte count in the iron group (89.4 (78.9 - 101.3) x 109 cells.l-1 (n = 39) vs the control (72.2 (63.9 – 86.4)) x 109 cells.l-1 (n = 41); p = 0.019; (mean (95% confidence intervals) of log transformed data).
There were no differences in final haemoglobin concentration (99.9 (95.7 – 104.2) vs 102.0 (98.7 - 105.3) p = 0.454) or transfusion requirements in the first week (11 (28%) vs 12 (29%); p = 0.899). Functional and safety outcomes were not different between the groups.

Conclusions: Although intravenous iron does stimulate erythropoiesis following hip fracture in older people, the effect is too small and too late to affect transfusion rates.

Citation

Moppett, I., Rowlands, M., Mannings, A., Marufu, T., Sahota, O., & Yeung, J. (2019). The effect of intravenous iron on erythropoiesis in older people with hip fracture. Age and Ageing, 48(5), 751–755. https://doi.org/10.1093/ageing/afz049

• Journal Article Type: Article
• Acceptance Date: Mar 27, 2019
• Online Publication Date: May 25, 2019
• Publication Date: Sep 1, 2019
• Deposit Date: Apr 1, 2019
• Publicly Available Date: May 26, 2020
• Journal: Age and Ageing
• Print ISSN: 0002-0729
• Electronic ISSN: 1468-2834
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 48
• Issue: 5
• Pages: 751–755
• DOI: https://doi.org/10.1093/ageing/afz049
• Keywords: Erythropoiesis; Iron; Anaemia; Blood transfusion; Hip fractures
• Public URL: https://nottingham-repository.worktribe.com/output/1722873
• Publisher URL: https://academic.oup.com/ageing/advance-article/doi/10.1093/ageing/afz049/5498578
• Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record I K Moppett, M Rowlands, A M Mannings, T C Marufu, O Sahota, J Yeung, The effect of intravenous iron on erythropoiesis in older people with hip fracture, Age and Ageing, , afz049, is available online at: https://doi.org/10.1093/ageing/afz049