From the Research
Iron transfusions prior to surgery should be considered when a patient has iron deficiency anemia with ferritin levels below 30 ng/mL or below 100 ng/mL with concurrent inflammatory conditions, and treatment should ideally begin 2-4 weeks before surgery. The general guideline for iron transfusion prior to surgery is based on the patient's iron deficiency anemia status and the timing of the surgery.
- Ferritin levels are a key indicator of iron stores, and levels below 30 ng/mL indicate depleted iron stores.
- In patients with inflammatory conditions, ferritin levels may be artificially elevated, so a cutoff of 100 ng/mL is used.
- Treatment with intravenous iron should begin 2-4 weeks before surgery to allow adequate time for erythropoiesis. Common IV iron preparations include:
- Iron sucrose (typically 200-300 mg per dose)
- Ferric carboxymaltose (up to 1000 mg per dose)
- Iron dextran (total dose infusion) The specific regimen depends on the severity of anemia, timing before surgery, and patient-specific factors, as noted in studies such as 1. Before administering IV iron, a complete blood count, iron studies (including ferritin, transferrin saturation), and renal function tests should be performed, as recommended by 2, 3. Patients should be monitored for potential adverse reactions during administration, including hypersensitivity reactions, as reported in 4. IV iron is preferred over oral iron preoperatively due to faster correction of iron deficiency, better absorption, and fewer gastrointestinal side effects, as shown in 5, 4. This approach helps optimize hemoglobin levels before surgery, potentially reducing the need for blood transfusions and improving surgical outcomes, as suggested by 1.