Treating Iron Deficiency Anaemia in Colorectal Cancer: A Safer And Cost Effective Solution?

JEF Fitzgerald, JAD Simpson, A Winton, E Toh, T Richards, MH Robinson, AG Acheson

Dept of Surgery & Medical Education Unit, Queens Medical Centre, Nottingham University Hospital, UK

Introduction
Iron deficiency anaemia (IDA) is common in colorectal cancer. Blood transfusion or oral supplements form current treatment. Transfusion carries risks and is expensive. Oral supplements may cause adverse reactions. IV iron therapy is regaining popularity in medicine following introduction of safer iron sucrose solutions. We identify colorectal cancer patients presenting with IDA in 2003-04, their transfusion requirements and costs of IV iron sucrose therapy.

Methods
Retrospective study of all patients undergoing colorectal cancer surgery in 2003-04. IDA defined: males Hb <13.5g/dL, females Hb <11.5g/dL, with MCV<84fl.
Table 1. Overall outcomes
Mean Stay (days) Patients with IDA Patients without IDA 12.2 Morbidity Mortality Dukes A Dukes B Dukes C

Figure 1. IV Venofer (iron sucrose) preparation

20%

18.3%

4.0%

40%

56%

13.2

17.9%

7.1%

20%

38.3%

41.7%

Results
217 patients underwent surgical resection within this 12 month period; 17 patients lacked sufficient recorded data and were excluded. The 200 remaining patients included 105 males and 95 females with a mean age of 70.8 years. Overall outcomes are shown in Table 1. Tumour site was recorded as right sided (37.4%), left sided (34.4%) and rectum (28.4%). 15% of patients had a preoperative Hb <10g/dL and 75% of those patients had right sided colorectal cancer. Statistical analysis (unpaired two-tailed t-test): Low pre-operative haemoglobin is associated with greater mortality (P = 0.0036, 95% CI 0.523-2.637) Low pre-operative haemoglobin is associated with greater morbidity (P = 0.0303, 95% CI 0.084-1.672) 52 units were transfused pre-operatively in 20 patients to correct IDA. Whole blood: 135/unit (April 07), average 351/patient, total = 7020. Iron sucrose protocols are not fully established. Typically four 200mg infusions/week for 2 weeks. Current price = 8.50/100mg ampoule: 136/patient; total = 2720.
Contact Mr Edward Fitzgerald: edwardfitzgerald@doctors.org.uk Presented at European Society of Coloproctology - Malta, September 2007

Figure 2. Administration of IV Venofer preparation

Conclusions
30% of patients undergoing colorectal cancer surgery had IDA, with higher risks of morbidity and mortality; in previous studies the link with morbidity has not been demonstrated. Pre-operative IDA can contribute to operative risk assessment. Correction with IV iron sucrose solution is safer and cheaper than transfusion. It warrants further investigation.

Acknowledgments
We gratefully acknowledge the support of Syner-Med UK for an travel award allowing this poster to be presented at the ESCP 2007.