Research Assistant Columbia University Irving Medical Center
Introduction: Iron deficiency(ID) is the leading cause of anemia worldwide and contributes to reduced physical and cognitive performance. Adolescents undergoing PSF for scoliosis are not routinely screened for ID, though their growth and development increase the body’s demand for iron while surgery-related bleeding and inflammation lead to further losses and iron sequestration.
Methods: Patients undergoing a primary PSF for scoliosis were prospectively enrolled in an observational cohort study of RBC and iron parameters from preoperative evaluation through surgical recovery. Baseline characteristics, laboratory findings, and RBC transfusion events were obtained from the EMR, while history of iron supplementation was provided by patient/parent report. Research specimens drawn at presentation for surgery and at follow-up included serum ferritin and soluble transferrin receptor concentration(sTfR), as well as RBC indices and other iron parameters. ID was defined as a ferritin < 25 µg/L and/or sTfR>4.4mg/L. Anemia was defined as Hg < 12g/dL for females and < 13g/dL for males.
Results: 46 participants(13 males,33 females) ranging in age from 11-18yrs were included. Baseline anemia was present in 17.4%(8/46) of patients. 13%(n=6) reported taking an iron supplement preoperatively. The rate of preoperative ID was 33.3%(14/42). RBC transfusion occurred in 10.8%(5/46) of patients, with ID patients being transfused more commonly than non-ID patients (35.7% vs. 0.0%,p=0.0024). In samples obtained 6-8 weeks postoperatively(n=24), ID was present in 73.9% of patients overall, while anemia was present in 50%.
Conclusion : Preoperative ID was observed in 1/3 of adolescents undergoing scoliosis surgery and was associated with a higher likelihood of RBC transfusion. At 6-8 weeks postop, the vast majority of patients were ID, and demonstrated abnormal RBC and/or other iron parameters. This data indicates the need for future studies examining the potential benefits of perioperative iron therapies and call for us to examine the extent of preventable perioperative harm.