Surgery and Transfusion Medicine

Among the most critical deficiencies in surgical patients, iron deficiency plays a significant role in pre-operative and post-operative Patient Blood Management (PBM), impacting both the response to surgery and the post-operative recovery process. Additionally, deficiencies in minerals and vitamins can hinder recovery and raise the risk of complications, particularly in patients undergoing enhanced recovery after surgery (ERAS) protocols or organ transplant recipients.

Iron deficiency in Patient Blood Management (PBM)

Preoperative iron deficiency is a common issue that can result in:

Increased risk of pre-operative anaemia, reducing the patient’s ability to handle surgery.
Increased need for blood transfusions, elevating the risk of infection and complications.
Slower post-operative recovery, with an increased incidence of cardiovascular issues and infections.

A proper PBM strategy includes early screening and treatment for iron deficiency before surgery. This is typically achieved through targeted oral supplementation, and, when necessary, intravenous iron for cases of moderate to severe anaemia. Correcting pre-operative iron deficiency is also crucial for reducing the need for transfusions.

Mineral and vitamin deficiency in post-operative recovery

In modern surgery, particularly within ERAS (Enhanced Recovery After Surgery) protocols, proper nutritional support is vital for facilitating faster recovery and reducing hospital stays. Some common deficiencies include:

Vitamin D3: Essential for bone metabolism and immune function. Vitamin D3 deficiency can increase the risk of infections and slow wound healing.
Vitamin B12: Important for red blood cell production and neurological health. Vitamin B12 deficiency can worsen post-operative anaemia and lead to neuropathy.
Magnesium: Crucial for muscle function and blood pressure regulation. Magnesium deficiency can cause muscle weakness, cramps and arrhythmias.
Zinc: Vital for wound healing and immune system function. Zinc deficiency can slow tissue repair and increase the likelihood of post-operative infections.
Vitamin C: Essential for collagen synthesis and tissue repair. Vitamin C deficiency impairs healing and increases the risk of infection.
Selenium: Important for antioxidant function and immune system support. Selenium deficiency is linked to increased oxidative stress and slower post-operative recovery.
Vitamin K: Crucial for blood clotting and wound healing. Vitamin K deficiency can increase the risk of bleeding and post-operative bleeding complications.

Optimising nutritional status before and after surgery is essential to reduce complications and improve surgical outcomes.

Magnesium deficiency in transplant patients

In organ transplant patients, the use of immunosuppressive drugs (such as calcineurin inhibitors) can lead to significant magnesium loss, with potential negative effects, including:

Increased risk of cardiac arrhythmias;
Higher incidence of muscle cramps and weakness;
Compromised kidney function in the long term.

Regular monitoring of magnesium levels and targeted supplementation are crucial to maintaining clinical stability and reducing the risk of complications in transplant patients.

Iron, mineral and vitamin supplementation: what surgical research says

Managing nutritional deficiencies in surgical patients is crucial for enhancing clinical outcomes and ensuring optimal recovery. Correcting iron deficiency in pre-operative and post-operative Patient Blood Management (PBM), providing nutritional support through ERAS protocols, and addressing magnesium deficiency in transplant patients are key strategies to reduce complications, optimise recovery and improve quality of life after surgery.

In relation to these aspects, clinical evidence indicates that the use of nutritional supplements based on minerals can significantly improve deficiency conditions in patients, both pre-operatively and during the recovery period, making a significant contribution to enhancing physical recovery and quality of life.

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Giordano G., Napolitano M., Di Battista V., Lucchesi A. Oral high-dose sucrosomial iron vs intravenous iron in sideropenic anemia patients intolerant/refractory to iron sulfate: a multicentric randomized study. Ann Hematol. 2021 Sep;100(9):2173-2179. doi: 10.1007/s00277-020-04361-3
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Scardino M., Di Matteo B., Martorelli F., Tanzi D., Kon E., D'Amato T. Improved patient blood management and cost saving in hip replacement surgery through the implementation of pre-operative Sucrosomial® iron supplementation: a quality improvement assessment study. Int Orthop. 2019 Jan;43(1):39-46. doi: 10.1007/s00264-018-4149-7.
Pierelli L., De Rosa A., Falco M., Papi E., Rondinelli M.B., Turani F., Weltert L. Preoperative Sucrosomial Iron Supplementation Increases Haemoglobin and Reduces Transfusion Requirements in Elective Heart Surgery Patients: A Prospective Randomized Study. Surg Technol Int. 2021 Oct 28; 39:321-328. doi: 10.52198/21.STI.39.CV1512.
Briguglio M., Hrelia S., Malaguti M., De Vecchi E., Lombardi G., Banfi G., Riso P., Porrini M., Romagnoli S., Pino F., Crespi T., Perazzo P. Oral Supplementation with Sucrosomial Ferric Pyrophosphate Plus L-Ascorbic Acid to Ameliorate the Martial Status: A Randomized Controlled Trial. Nutrients. 2020 Jan 31;12(2):386. doi: 10.3390/nu12020386.
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Torreiter P.P., Drexler-Helmberg C., Schimetta W., Krakowitzky P., Helmberg W., Schlenke P. Pilot Study to Gain First Indications for the Impact of a 3-Month's Oral Intake of a Sucrosomial Iron Supplement on Hemoglobin in Iron-Deficient Blood Donors. Transfus Med Hemother. 2022 Dec 6;50(4):286-293. doi: 10.1159/000527577

Surgery and Transfusion Medicine

Iron deficiency in Patient Blood Management (PBM)

Mineral and vitamin deficiency in post-operative recovery

Magnesium deficiency in transplant patients

Iron, mineral and vitamin supplementation: what surgical research says

Published Clinical Studies on the use of Sucrosomial® Iron in Transfusion Medicine and PBM:

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