Preview

Russian journal of hematology and transfusiology

Advanced search

Dynamic laboratory control of iron deficiency correction in neurosurgical patients

https://doi.org/10.35754/0234-5730-2022-67-4-500-509

Abstract

Introduction. The concept of blood management in relation to the surgical treatment of surgical diseases recommends the correction of iron defi ciency anemia (IDA) at the prehospital stage. However, surgery is often performed for emergency indications, making it necessary to carry out treatment as soon as possible.

Aim – to evaluate the possibilities of using delta hemoglobin (Delta-He) to monitor the effectiveness of IDA therapy in neurosurgical patients at the prehospital stage to reduce the time required to prepare patients for hospitalization.

Materials and methods. A total of 42 patients were treated with high-dose iron preparations (iron [III] carboxymaltosate and iron [III] hydroxide oligoisomaltosate). During the treatment, the dynamics of the number of reticulocytes and the values of the hemoglobin delta were evaluated. Data are presented as median (IQR).

Results. Treatment with high-dose iron preparations led to an increase in Delta-He values starting from days 1–2. Significant changes were recorded by days 3–4 from the start of therapy: from 2.2 (0.3–4.9) pg to 15.5 (13.8–10) pg on day 7. These changes were 2–3 days ahead of the increase in the number of reticulocytes in the corresponding blood samples: the number of reticulocytes significantly increased by days 5–6 from the start of treatment.

Conclusion. The use of high-dose preparations of iron [III] carboxymaltosate and iron [III] hydroxide oligoisomaltosate in the form of infusion made it possible to prepare neurosurgical patients for hospitalization within a week. None of the patients required transfusion of erythrocyte-containing components of donated blood at any stage of surgical treatment. The ability to focus on Delta-He values instead of the number of reticulocytes during iron therapy made it possible to shorten the waiting period for the effect of drug exposure by 2–3 days.

About the Authors

N. B. Teryaeva
N.N. Burdenko National Medical Research Center of Neurosurgery
Russian Federation

Nadezhda B. Teryaeva, Cand. Sci. (Med.), Doctor of Laboratory Diagnostics

125047, Moscow



O. K. Kvan
N.N. Burdenko National Medical Research Center of Neurosurgery
Russian Federation

Oksana K. Kvan, Head of the Department of Clinical and Productional Transfusion

125047, Moscow



O. A. Gadjieva
N.N. Burdenko National Medical Research Center of Neurosurgery
Russian Federation

Olga A. Gadjieva, Cand. Sci. (Med.), Head of the Clinical Diagnostic Laboratory

125047, Moscow



B. A. Bashiryan
N.N. Burdenko National Medical Research Center of Neurosurgery
Russian Federation

Boris A. Bashiryan, Doctor of Laboratory Diagnostics

125047, Moscow



References

1. Comín-Colet J., Enjuanes C., González G., et al. Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of аnaemia status. Eur J Heart Fail. 2013; 15(10): 1164–72. DOI: 10.1093/eurjhf/hft083.

2. Goodnough L.T., Maniatis A., Earnshaw P., et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth. 2011; 106(1): 13–22. DOI: 10.1093/bja/aeq361.

3. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011. https://apps.who.int/iris/handle/10665/85839

4. Hoenemann C., Ostendorf N., Zarbock A., et al. Reticulocyte and erythrocyte hemoglobin parameters for iron deficiency and anemia diagnostics in patient blood management. A narrative review. J Clin Med. 2021; 10(18): 4250. DOI: 10.3390/jcm10184250.

5. Desborough J.P. Stress response to trauma and surgery. Br J Anaesth. 2000; 85(1): 109–17. DOI: 10.1093/bja/85.1.109.

6. Burton D., Nicholson G., Hall G. Endocrine and metabolic response to surgery. CEACCP. 2004; 4(5): 144–7. DOI: 10.1093/bjaceaccp/mkh046.

7. Pagani A., Nai1 A., Silvestri L., Camaschella C. Hepcidin and anemia: A tight relationship. Front Physiol. 2019; 10: 1294. DOI: 10.3389/fphys.2019.01294.

8. Petrova J., Manolov V., Vasilev V., et al. Ischemic stroke, inflammation, iron overload — Connection to a hepcidin. Int J Stroke. 2016; 11(1): NP16–7. DOI: 10.1177/1747493015607509.

9. de Mast Q., van Dongen-Lases E.C., Swinkels D.W., et al. Mild increases in serum hepcidin and interleukin-6 concentrations impair iron incorporation in haemoglobin during an experimental human malaria infection. Br J Haematol. 2009; 145(5): 657–64. DOI: 10.1111/j.1365-2141.2009.07664.x.

10. Potapnev M.P., Leshchuk S.P. Transfusion-related immunomodulation. Clinical effects and mechanisms of action. Transfusiologiya. 2013; 14(2): 27–48. (In Russian).

11. Baranov I.I., Salnikova I.A., Nesterova L.A. Clinical practice guidelines for the diagnosis and treatment of iron deficiency: The view from 2022. Akusherstvo I ginekologiya: Novosti, mneniya obuchenie. 2022; 10(2): 56–64. DOI: 10.33029/2303-9698-2022-10-2-56-64. (In Russian).

12. Vorobiev P.A. Anemic syndrome in clinical practice. Moscow: Newdiamed Publ., 2001. (In Russian).

13. Weimann A., Cremer M., Hernáiz-Driever P., Zimmermann M. Delta-He, Ret-He and a new diagnostic plot for differential diagnosis and therapy monitoring of patients suffering from various disease-specific types of anemia. Clin Lab. 2016; 62(4): 667–77. DOI: 10.7754/clin.lab.2015.150830.

14. Schoorl M., Schoorl M., Linssen J., et al. Efficacy of advanced discriminating algorithms for screening on iron-deficiency anemia and β-thalassemia trait: A multicenter evaluation. Am Clin Pathol. 2012; 138(2): 300–4. DOI: 10.1309/AJCP20UTTCAYKUDX.

15. Slaats J., Oever J.T., van de Veerdonk F.L., Netea M.G. IL-1β/IL-6/CRP and IL-18/ferritin: Distinct inflammatory programs in infections. PLoS Pathog. 2016; 12(12): e1005973. DOI: 10.1371/journal.ppat.1005973.

16. Schoorl M., Schoorl M., van Pelt J., Bartels P.C.M. Application of innovative hemocytometric parameters and algorithms for improvement of microcytic anemia discrimination. Hematol Rep. 2015; 7(2): 5843. DOI: 10.4081/hr.2015.5843.

17. Bokerija L.A., Teryaeva N.B., Egorova M.O., et al. Biochemical parameters of blood in the postoperative period during closed heart surgery. Byulleten NTSSSKH im. A.N. Bakuleva RAMN «Serdechno-sosudistye zabolevaniya». 2003; 4(7): 47–52. (In Russian).

18. Teryaeva N.B., Gadzhieva O.A., Nazarov V.V., et al. Delta-He — a new biomarker for a surgical clinic. Voprosy neurochirurgii imeni N.N. Burdenko. 2022; 86(4): 60–5. DOI: 10.17116/neiro20228604160. (In Russian).

19. Jahn M.R., Andreasen H.B., Fütterer S., et al. A comparative study of the physicochemical properties of iron isomaltoside 1000 (Monofer), a new intravenous iron preparation and its clinical implications. Eur J Pharm Biopharm. 2011; 78(3): 480–91. DOI: 10.1016/j.ejpb.2011.03.016.

20. Kalra P.A., Bhandari S. Efficacy and safety of iron isomaltoside (Monofer) in the management of patients with iron deficiency anemia. Int J Nephrol Renovasc Dis. 2016; 9: 53–64. DOI: 10.2147/IJNRD.S89704.

21. Bailie G.R., Mason N.A., Valaoras T.G. Safety and tolerability of intravenous ferric carboxymaltose in patients with iron deficiency anemia. Hemodial Int. 2010; 14(1): 47–54. DOI: 10.1111/j.1542-4758.2009.00409.x.

22. Onken J.E., Bregman D.B., Harrington A.R., et al. A multicenter, randomized, active‐controlled study to investigate the efficacy and safety of intravenous ferric carboxymaltose in patients with iron deficiency anemia. Transfusion. 2014; 54(2): 306–15. DOI: 10.1111/trf.12289.

23. Seid M.H., Mangione A., Pharm D., et al. Safety profile of iron carboxymaltose, a new high dose intravenous iron in patients with iron deficiency anemia. Blood. 2005; 108(11): 3739. DOI: 10.1182/blood.V108.11.3739.3739.

24. Breymann C., Milman N., Mezzacasa A., et al. Ferric carboxymaltose vs. oral iron in the treatment of pregnant women with iron deficiency anemia: An international, open-label, randomized controlled trial (FER-ASAP). J Perinatal Med. 2017; 45(4): 443–53. DOI: 10.1515/jpm-2016-0050.

25. Calleja J.L., Delgado S., del Val A., et al. Ferric carboxymaltose reduces transfusions and hospital stay in patients with colon cancer and anemia. Int J Colorectal Dis. 2016; 31(3): 543–51. DOI: 10.1007/s00384-015-2461-x.

26. Bernd F., Palm P., Weber I., et al. The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: A randomized controlled trial. Ann Surg. 2018; 267(2): e39–40. DOI: 10.1097/SLA.0000000000002055.

27. Bhandari S. Beyond efficacy and safety-the need for convenient and cost-effective iron therapy in health care. NDT Plus. 2011; 4(Suppl. 1): i14–9. DOI: 10.1093/ndtplus/sfr044.

28. Prescribing Information for Ferinject® 50 mg/mL IV Solution, Marketing Authorization: LRS-008848/10 of 30.08.2010. (In Russian).

29. Prescribing Information for for Monofer® 100 mg/mL IV Solution, Marketing Authorization: LP-001499 of 13.02.2012. (In Russian).

30. Hattangadi S.M., Wong P., Zhang L., et al. From stem cell to red cell: Regulation of erythropoiesis at multiple levels by multiple proteins, RNAs, and chromatin modifications. Blood. 2011; 118(24): 6258–68. DOI: 10.1182/blood-2011-07-356006.

31. Kosmachevskayaa O.V., Nasybullinaa E.I., Blindarb V.N., Topunov A.F. Binding of erythrocytic hemoglobin to the membrane as a mode to realize signal-regulatory function. Review. Prikladnaya biokhimiya i mikrobiologiya. 2019; 55(2): 107–23. DOI: 10.1134/S0555109919020090. (In Russian).


Review

For citations:


Teryaeva N.B., Kvan O.K., Gadjieva O.A., Bashiryan B.A. Dynamic laboratory control of iron deficiency correction in neurosurgical patients. Russian journal of hematology and transfusiology. 2022;67(4):500-509. (In Russ.) https://doi.org/10.35754/0234-5730-2022-67-4-500-509

Views: 922


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 0234-5730 (Print)
ISSN 2411-3042 (Online)