01 December 2023

Giving iron intravenously before colorectal surgery reduces the need for blood transfusion by 33%, British researchers reported recently.

Researchers from University College London and the Royal Devon and Exeter Hospital carried out a meta-analysis of five randomised controlled trials, focusing on a subset of patients who had undergone bowel surgery.

In these trials, patients were split into two groups: a control group and a group who received iron intravenously prior to surgery.

Writing in The British Journal of Surgery, their analysis showed that patients who had received iron infusion were 33% less likely than others to require a blood transfusion during or after surgery.

The authors note however that the long-term benefits and risks of this approach are still uncertain, and a health economics analysis is needed.

Senior author Professor Toby Richards, from UCL Division of Surgery & Interventional Sciences, said: “This is the first time that clinical trials have shown a patient benefit from treatment with an iron infusion before surgery, which has the potential to treat anaemia and reduce the need for blood transfusion.

“Previous studies had not shown this benefit for all patients undergoing surgery in the NHS, but this analysis identifies a subset of patients undergoing bowel surgery who will see a benefit.”

Co-lead study author Professor Neil Smart, colorectal surgeon from the Royal Devon and Exeter Hospital, said: “with over 20,000 major colorectal cancer resections per year in the UK, the findings of this study have the potential to improve outcomes for the second most common cause of cancer mortality.

“In the past, surgeons were uncertain whether the benefits of iron infusion could be realised in the short time frames of cancer care and consequently the uptake of this treatment was limited,” he said.

“Our findings show that improved outcomes can be achieved if iron infusion is given in the period between cancer diagnosis and surgery.”

Sue Pavord, vice president of British Society for Haematology, added that the recent shortage of blood supply in the UK means it is important to find ways to avoid blood transfusions and their associated risks.


Lederhuber H, Massey LH, Abeysiri S, Roman MA, Rajaretnam N, McDermott FD, Miles LF, Smart NJ, Richards T. (2023) “Preoperative intravenous iron and the risk of blood transfusion in colorectal cancer surgery: a meta-analysis of randomised controlled trials.” British Journal of Surgery, doi: 10.1093/bjs/znad320

Link: https://academic.oup.com/bjs/article-lookup/doi/10.1093/bjs/znad320

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