From the Guidelines
Low ferritin levels should be treated before elective surgery to improve surgical outcomes, and the most effective approach is to use intravenous iron formulations like ferric carboxymaltose, which can rapidly replenish iron stores and improve hemoglobin levels, as shown in a study published in 2022 1.
Importance of Treating Low Ferritin Levels
Patients with low ferritin may experience increased risk of complications including poor wound healing, increased infection rates, fatigue, and reduced tolerance to blood loss.
- The recommended approach is to identify and treat iron deficiency preoperatively, typically with oral iron supplements such as ferrous sulfate 100-200 mg/day, in divided doses, as suggested by the espen micronutrient guideline 1.
- For severe deficiency or when surgery is urgent, intravenous iron formulations like iron sucrose or ferric carboxymaltose may be used for faster repletion, with a single dose of 1 g element iron as ferric carboxymaltose associated with a reduction of length of hospital stay and of 90-day mortality 1.
Treatment Timing and Investigation of Underlying Cause
Treatment should begin at least 4-6 weeks before elective surgery to allow adequate time for iron stores to replenish and hemoglobin levels to improve.
- The underlying cause of iron deficiency should also be investigated, as it may be due to chronic blood loss, malabsorption, or poor dietary intake, and addressing this can help prevent future deficiencies.
- Optimizing iron status before surgery helps improve oxygen-carrying capacity of the blood, enhances immune function, and supports tissue repair processes, all of which contribute to better surgical outcomes and faster recovery, as supported by guidelines for perioperative care in elective colorectal surgery 1.
From the FDA Drug Label
Inclusion criteria prior to randomization included hemoglobin (Hb) <12 g/dL, ferritin ≤100 ng/mL or ferritin ≤300 ng/mL when transferrin saturation (TSAT) ≤30%. Iron deficiency was defined as serum ferritin <100 ng/mL or 100 to 300 ng/mL with TSAT <20%. Increases from baseline in mean ferritin (264.2 ± 224.2 ng/mL in Cohort 1 and 218.2 ± 211. 4 ng/mL in Cohort 2), and transferrin saturation (13 ± 16% in Cohort 1 and 20 ± 15% in Cohort 2) were observed at Day 35 in Injectafer-treated patients Increases from baseline in mean ferritin (734.7 ± 337.8 ng/mL) and transferrin saturation (30 ± 17%) were observed prior to Day 56 in Injectafer-treated patients. Change from Baseline to Week 24 in serum ferritin was 269 ng/mL (229,309), in TSAT was 9% (7,11), and in Hb was 0.6 g/dL (0.3,0. 8).
Low Ferritin Levels and Surgical Outcomes: The provided drug label does not directly address the relationship between low ferritin levels and surgical outcomes. However, it does discuss the treatment of iron deficiency anemia with ferric carboxymaltose, which can increase ferritin levels.
- Key Points:
- Ferritin levels are used to define iron deficiency.
- Treatment with ferric carboxymaltose can increase ferritin levels.
- The label does not provide information on the direct relationship between ferritin levels and surgical outcomes. Given the information available, no conclusion can be drawn about the specific relationship between low ferritin levels and surgical outcomes from this drug label 2.
From the Research
Low Ferritin Level and Surgical Outcomes
- Low ferritin levels have been associated with poor surgical outcomes, including increased mortality and morbidity 3
- Iron deficiency, characterized by low ferritin levels, is common in patients undergoing surgery and can lead to anemia, which can increase the risk of blood transfusions and prolong hospital stays 4, 5
- Studies have investigated the use of iron therapy, including intravenous and oral iron supplementation, to correct anemia and improve surgical outcomes 6, 5, 7
Iron Therapy and Surgical Outcomes
- Intravenous iron therapy has been shown to increase hemoglobin and ferritin levels, but its effect on reducing blood transfusions and improving surgical outcomes is still unclear 6, 5, 7
- Oral iron therapy may not be as effective as intravenous iron therapy in increasing hemoglobin and ferritin levels, but it may still be beneficial in correcting anemia 5, 7
- The timing and duration of iron therapy may be important factors in determining its effectiveness in improving surgical outcomes 6, 5
Mortality and Morbidity
- Low ferritin levels have been associated with increased mortality and morbidity in patients undergoing cardiac surgery 3
- Iron deficiency has been shown to increase the risk of serious adverse events, major cardiac and cerebrovascular events, and prolonged hospital stays 3
- Correcting iron deficiency and anemia may be important in reducing the risk of mortality and morbidity in patients undergoing surgery 4, 5, 3