TITLE:
Resolution of Cardiac Symptoms through Preoperative Intravenous Iron Supplementation in a Cancer Patient
AUTHORS:
Anja-Claudine Nawratil, Marc Moritz Berger, Alexander Geisberger
KEYWORDS:
Patient Blood Management, Iron Deficiency, Anesthesia, Anaemia, Heart Failure
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.8 No.7,
July
9,
2019
ABSTRACT:
Cardiologic assessment was
conducted on a 78-year-old male patient scheduled for elective aortic valve
surgery who complained of angina and dyspnea that had arisen over the previous
few months. Evaluation showed stable
coronary artery disease and iron deficiency anemia (hemoglobin, 7.7 g/dL).
Colonoscopy revealed a non-stenosing carcinoma of the right colonic
flexure that was causing chronic blood loss. The interdisciplinary tumor board
of the hospital decided that his need for an extended right hemicolectomy
followed by resection of two pulmonary nodules that were suspicious of
metastatic lesions had priority over his cardiac surgery. Prior to abdominal
surgery, the patient received 4 × 500 mg intravenous iron (Ferric-Carboxymaltose) over 2 weeks, for correction
of iron deficiency and optimization of hemoglobin concentration. This treatment
led to rapid improvement of his angina and exertion-induced dyspnea. His
hemoglobin concentration continued to rise even after completion of the iron supplementation, and reached normal levels
before thoracoscopic removal of the lung nodules, which took place 1 month
after resection of the colon tumor. The patient remained in good clinical
condition without any need for blood transfusions. As follow-up visits showed
persistent abatement of angina and dyspnea, aortic valve surgery and other cardiac
interventions were no longer deemed necessary.