Moppett, Iain, Rowlands, Matt, Mannings, Alexa, Marufu, Takawira, Sahota, Opinder and Yeung, Joyce (2019) The effect of intravenous iron on erythropoiesis in older people with hip fracture. Age and Ageing . doi:10.1093/ageing/afz049 (In Press)

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Abstract

Background
anaemia following hip fracture is common and associated with worse outcomes. Intravenous iron is a potential non-transfusion treatment for this anaemia and has been found to reduce transfusion rates in previous observational studies. There is good evidence for its use in elective surgical populations.

Objective
to examine the impact of intravenous iron on erythropoiesis following hip fracture.

Design
two-centre, assessor-blinded, randomised, controlled trial of patients with primary hip fracture and no contra-indications to intravenous iron.

Method
the intervention group received three doses of 200 mg iron sucrose over 30 min (Venofer, Vifor Pharma, Bagshot Park, UK) on three separate days. Primary outcome was reticulocyte count at day 7 after randomisation. Secondary outcomes included haemoglobin concentration, complications and discharge destination. Eighty participants were randomised.

Results
there was a statistically significantly greater absolute final reticulocyte count in the iron group (89.4 (78.9–101.3) × 109 cells l−1 (n = 39) vs. the control (72.2 (63.9–86.4)) × 109 cells l−1 (n = 41); P = 0.019; (mean (95% confidence intervals) of log-transformed data). There were no differences in final haemoglobin concentration (99.9 (95.7–104.2) vs. 102.0 (98.7–105.3) P = 0.454) or transfusion requirements in the first week (11 (28%) vs. 12 (29%); P = 0.899). Functional and safety outcomes were not different between the groups.

Conclusions
although intravenous iron does stimulate erythropoiesis following hip fracture in older people, the effect is too small and too late to affect transfusion rates. Trial Registry Numbers: ISRCTN:76424792; EuDRACT: 2011-003233-34.

Item Type:	Journal Article
Subjects:	Q Science > QP Physiology R Medicine > R Medicine (General) R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Erythropoiesis , Erythropoietic failure, Anemia , Geriatrics, Blood -- Transfusion, Fractures in old age -- Treatment, Pelvic bones -- Fractures
Journal or Publication Title:	Age and Ageing
Publisher:	Oxford University Press
ISSN:	0002-0729
Official Date:	25 May 2019
Dates:	Date Event 25 May 2019 Available 27 March 2019 Accepted
Date of first compliant deposit:	29 April 2019
DOI:	10.1093/ageing/afz049
Status:	Peer Reviewed
Publication Status:	In Press
Publisher Statement:	This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record I K Moppett, M Rowlands, A M Mannings, T C Marufu, O Sahota, J Yeung, The effect of intravenous iron on erythropoiesis in older people with hip fracture, Age and Ageing, , afz049, is available online at: https://doi.org/10.1093/ageing/afz049
Access rights to Published version:	Restricted or Subscription Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Association of Anaesthetists of Great Britain and Ireland http://dx.doi.org/10.13039/501100007567
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