engleski

Intravenous iron supplementation for treatment of postoperative anemia in patient with prolonged vascular graft infection.

Case report: A 65-year old male patient was admitted on the vascular Surgery department with abdominal aortic graft infection and severe deep skin infection of the left lower leg, of unknown cause. Relevant medical history. Four years ago, he underwent emergency aortic graft reconstruction with Dacron graft prosthesis after rupture of an abdominal aortic aneurysm with duodenal fistula. He had received massive transfusion at that time. In the early postoperative period, he had myocardial infarction and underwent triple coronary artery bypass grafting. Until two months before this hospitalization, he was in good condition, asymptomatic, but a diagnosis of systemic infection and severe deep skin infection of the left lower leg and aortic graft infection was made and a re operation was indicated. Surgery. In the first stage, incision of lower leg abscess was performed. 7 days later, the prosthesis was removed and aortic reconstruction with cryopreserved aortic homograft was performed. Post-surgical course. He was severely anaemic and had prolonged hospitalization. Despite high ferritin levels, in order to avoid blood transfusion, the patient had received intravenous iron supplementation. After 63 days he was discharged from hospital in good condition. DISCUSSION Elemental iron is an essential growth factor for bacteria, with many species expressing iron transport proteins that compete with transferrin, an it has long been suggested that patients with iron overload are at increased risk of infection. However, data from meta-analyses and large observational studies showed that peri-operative i.v. form did not increase postoperative infection or 30-day mortality rates in surgical patients. In contrast, red cell transfusion delivers haem and labile iron which supports bacterial growth. CONCLUSION:Transfusion is an independent, dose-dependent and additive risk factor for morbidity, average duration of stay and mortality in most clinical settings.

aortic graft infection, postoperative anemia, intravenous iron supplementation

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