24 May 2016

Iron deficiency in coronary artery surgery patients - the HERROES substudy

Dr Joel Symons with a patient
Dr Joel Symons was awarded the Robin Smallwood bequest from the Australian and New Zealand College of Anaesthetists for $98,000 to complete a substudy HEpcidin, Reticulocyte haemoglobin and soluble transferrin Receptors in Reported OutcomEs in cardiac Surgery (HERROES) sub study, nested within ITACS commencing in 2016.

Iron deficiency is very common in patients having coronary artery surgery. It is the commonest cause of anaemia worldwide, and independently worsens outcomes after surgery. The ITACS trial will determine whether a single dose of IV iron, given to anaemic patients before elective cardiac surgery improves outcome after surgery. The primary endpoint is days alive and out of hospital from surgery to 30 days following operation.  Secondary endpoints include blood transfusions, perioperative complications, hospital stay, survival, quality of life and disability-free survival.


The HERROES sub study will investigate markers of iron deficiency in the perioperative period and whether these can predict response to iron therapy. Most studies on iron deficiency and iron deficiency anaemia use haemoglobin, transferrin saturation and ferritin as markers of iron deficiency and response to iron supplementation. These markers are not useful because they are unable to distinguish between patients with absolute iron deficiency and those that have functional iron deficiency (i.e. those patients who are unable to utilise iron effectively). STrF-log F levels, Ret-Hb content and hepcidin may be better at monitoring response to IV iron therapy in patients undergoing elective cardiac surgery because they give a better picture of iron storage and utilisation than currently performed iron studies.

STrF-log F levels, Ret-Hb content and hepcidin levels may allow the perioperative clinician to better characterise iron deficiency, and its response to treatment, in the elective cardiac surgical population and therefore aid in more targeted and cost-effective iron supplementation to correct iron deficiency and improved both short and long-term outcomes in all patients.

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