Iron deficiency anaemia and iron depletion are a major public health issue even in Western industrialised countries. It is estimated that the prevalence of anaemia is 4.1% in men and 10.8% in women. In men the highest prevalence is in the over 65s, whilst in women it is in the age range 16-44 years. The elderly in care homes have a risk more than twice that of private households. (A National Blood Conversation Strategy for NBTC and NBS)
The assessment of iron status in both medical and surgical patients and the appropriate management of iron deficiency would reduce the need for blood transfusion. Both oral iron tablets and intravenous iron sucrose are inexpensive products compared with the transfusion of red cells or the use of erythropoietin.
The Handbook of Transfusion Medicine quotes: (page 24 or link here).
The World Health Organisation definition states that anaemia should be considered to exist in adults whose haemoglobin levels are lower than 13g/100ml (males) or 12g/100ml (females). The U.S. Cancer Institute considers normal haemoglobin levels to be 12-16g/100ml (females) and 14-18g/100ml (males).
In elective surgery
Adequate iron stores are necessary to allow increased erythropoiesis following surgical blood loss. Iron should be prescribed for those patients who are known to have a low ferritin or who are being treated with erythropoietin (Epo).
Some evidence suggests that ferrous sulphate, given for four weeks preoperatively to all patients undergoing elective orthopaedic surgery, leads to improved postoperative haemoglobins (British Orthopaedic Association 2005)
preoperative parenteral iron therapy may be preferential in some patients (generally those with anaemia of chronic disease, eg rheumatoid arthritis, urgent treatment of iron deficiency anaemia, or non-compliance with oral preparations. This should be given in consultation with local haematologists.
Iron in pregnancy
See the Toolkit section 'Antenatal obstetric care'.
This page was last reviewed on 02/08/2010