IS PREOPERATIVE FERROUS SULPHATE SUPPLEMENTATION BENEFICIAL IN PATIENTS UNDERGOING PRIMARY TOTAL HIP ARTHROPLASTY (THA).

Abstract

Introduction: The purpose of this study was to evaluate the effect of preoperative oral ferrous sulphate supplementation on the haemoglobin status of a group of patients undergoing primary THA and the incidence of homologous blood transfusion in them.

Methods: The authors prospectively studied 107 consecutive patients scheduled to undergo primary THA. All the patients were given ferrous sulphate, 200mg twice a day for a minimum of 21 days, six weeks prior to their proposed operation. We excluded patients on medications that can interfere with iron metabolism.89 patients managed to complete the course. To aid compliance the investigators collected tablet bottles after completion of the course. Haemoglobin (Hb), Mean Corpuscular Haemoglobin and Mean Cell Volume was conducted at the start, on the day before surgery and the second postoperative day. The details for blood transfusion were also recorded. We compared these patients to control group of demographically similar 90 patients, who did not have iron supplementation.

Results: 19 patients (21%) were anaemic at the start of the therapy.72 patients had rise in their haemoglobin by a mean of 0.61 g. In the study group16 patients (18%) had a blood transfusion as compared to 23 patients (26%) in the control group. Patients with preoperative Hb above 13.5g did not require transfusion in both study and control group.15 patients in the study group increased their Hb above 13.5 gdl, and were likely saved from requiring a transfusion. The relationship between the iron status and blood transfusion requirement was not statistically significant.

Discussion: The incidence of preoperative anaemia is significant in patients undergoing THA. Ferrous sulphate therapy on its own did not reduce the blood transfusion requirement. Non-anaemic patients seem to benefit most with iron supplementation, in terms of avoiding blood transfusion. Combination of early screening, appropriate treatment pre-operatively and strict guidelines may help reduce the incidence of blood transfusion.