Abstract
Background: Red blood cell transfusions are necessary both during and after spine fusion surgery for scoliosis. The study aimed to evaluate the response of patients with iron deficiency or anemia undergoing adolescent scoliosis correction to ultra-short-term treatment with ferric carboxymaltose, subcutaneous erythropoietin, subcutaneous vitamin B12, and oral folic acid.
Methods: Forty-four patients aged 13 to 45 years with adolescent idiopathic scoliosis slated for surgical treatment by posterior fusion spine surgery were divided into two groups. One day before the operation, patients in the Therapy group received a gradual intravenous infusion of 20 mg/kg ferric carboxymaltose, 40.000 Unit subcutaneous erythropoietin, 1 mg subcutaneous vitamin B12, and 5 mg oral folic acid. Patients in the Control group got a placebo treatment. The number of red blood cell and platelet transfusions received during the first postoperative seven days, the perioperative Hemoglobin, reticulocyte, platelet, and leucocyte count, reticulocyte hemoglobin content, the need for fresh frozen plasma units, and intraoperative blood loss were recorded.
Results: The therapy group presented significantly lower mean value of intraoperative blood loss, number of patients who required platelet, fresh frozen plasma, and RBC transfusions than in the control group. The therapy group considerably enhances postoperative total leukocyte count and platelet count. In the therapy group, postoperative hemoglobin [HB], reticulocyte [RTC], and RTC-HB values were considerably greater than in the control group.
Conclusion: Preoperative combined administration of ferric carboxymaltose, erythropoietin, vitamin B12, and folic acid in adolescent idiopathic scoliosis correction one day before the surgery, could improve postoperative outcomes by optimizing preoperative anemia, reducing intraoperative blood loss and the number of patients requiring blood products and shorter intensive care unit [ICU] stay.
Trial registration: Registered on ClinicalTrials.gov with the ID: NCT04343170 on the date of April 2020. https://clinicaltrials.gov/ct2/show/NCT04343170