A presentation at the ASH annual meeting challenged the belief that intravenous iron should not be administered to patients with iron-deficiency anemia (IDA) and a simultaneous acute bacterial infection because it might worsen the infection.
Haris Sohail, MD, presented plenary abstract 5: Deciphering the dilemma: Intravenous (IV) iron use in iron deficiency anemia during acute infections, which evaluated the impact of IV iron on survival and hemoglobin recovery in hospitalized adults with IDA and acute infection.
Data from over 85,000 adult patients from 2000 to 2024 with IDA and acute infections, including MRSA bacteremia, pneumonia, urinary tract infection, colitis, or cellulitis treated with antibiotics were analyzed from the TriNetX Research Network. Patients who received IV iron up to a week after IDA and infection were matched with those who didn’t.
Patients who received IV iron had better survival at both 14 and 90 days, better hemoglobin recovery, and reduced transfusions across all infection cohorts. Dr. Sohail concluded, “While prospective trials are needed to confirm these real-world findings, data suggests withholding IV iron due to infection is likely unnecessary, especially in patients who have profound anemia.”
Brett Houston, MD, presented late-breaking abstract 5, results of a phase IV trial of a hospital policy of tranexamic acid to reduce transfusion in major non-cardiac surgery (TRACTION).
Perioperative bleeding is a leading indication for red blood cell (RBC) transfusion among hospitalized patients. Blood is an expensive, limited resource, underscoring the need for strategies to reduce transfusion.
Tranexamic acid (TXA) is an inexpensive, widely available antifibrinolytic agent, with an established side effect profile. Although TXA reduces RBC transfusion in cardiac surgery and hip and knee arthroplasty, unresolved concerns of potential thrombotic complications, particularly among patients with cancer, has affected adoption.
This Canadian multi-center (N=10), cluster cross-over trial asked if hospital-level implementation of TXA in adults undergoing major non-cardiac surgery could safely reduce RBC transfusion without increasing thrombotic risk. Hospitals were randomized 1:1 at 4 week intervals to TXA or placebo from February 2022 through March 2024. Patients received 1 gram TXA within 10 minutes of surgical incision and 1 gram TXA prior to skin closure (n=4156), or saline placebo (n=4117).
TXA reduced the proportion of patients transfused RBC 7.4% vs 9.8%, a 2.4% absolute risk reduction. TXA did not increase venous thromboembolism overall at 90 days, nor in any prespecified subgroup, including patients undergoing cancer surgery. There was no difference in hospital diagnoses of cardiovascular events, length of stay, survival in hospital or at 90 days.
If TXA were broadly implemented, 1-2 million people could avoid perioperative RBC transfusion, saving 5-10 million units. Dr. Houston noted the novel trial design reduced the cost to a fraction of that of a typical trial of its size.
Dr. Martin Dreyling, coordinator of the European Coalition for Reducing Bureaucracy in Clinical Trials said, “This is highly clinically relevant. It improves patient care, it’s cheap, and it really tells you that a lot of things we are doing in standard clinical trials are throwing money out the window.”
Dr. Lederman has no conflicts of interest to report.
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