Trauma Clinical Trial
Official title:
A Multicenter, Randomized, Double-blind Comparison of Intravenous Iron Supplementation to Placebo for the Treatment of Anemia of Traumatic Critical Illness
The purpose of this clinical trial is to determine whether intravenous iron supplementation of anemic, critically ill trauma patients improves anemia and reduces the need for a red blood cell transfusion.
Nearly all trauma patients admitted to an intensive care unit (ICU) are anemic (low red blood
cell counts). Anemia is an independent risk factor for poor outcomes, including infection,
impaired wound healing, and death. Current therapies for ICU anemia are unsatisfactory: Red
blood cell (RBC) transfusion is associated with an increased risk of immune suppression,
infection, and organ failure. Furthermore, use of both hemoglobin replacement products and
erythropoietin are limited by expense as well as unfavorable side effect profiles.
One principal cause of anemia in trauma ICU patients involves disturbances in iron
metabolism. Iron is necessary to make RBCs, and a lack of iron delivered to the bone marrow
results in anemia. Trauma causes diversion of iron from the bone marrow into storage, where
it cannot participate in the generation of RBCs. This diversion of iron is caused by
inflammatory proteins released as a result of tissue injury.
Previous work by the principal investigator among ICU patients suggested a benefit to oral
iron supplementation administered in dosages similar to those used in a standard
multivitamin. However, many patients were not able to tolerate oral medications, and this
study was not specific to trauma patients. Additional research has suggested that intravenous
iron supplementation is effective in treating anemic patients with other inflammatory
conditions, such as cancer and inflammatory bowel disease. However, the benefit of
intravenous iron supplementation has never been tested among anemic ICU patients, including
trauma patients.
The current clinical trial will evaluate the risk/benefit profile of intravenous iron
supplementation among anemic trauma ICU patients. The study will take place over several
academic trauma centers with a long history of participation in translational research.
Anemia remains a devastating complication of trauma. Current treatment options are limited.
Intravenous iron supplementation represents a targeted, cost-effective solution to this
pervasive problem, the efficacy of which remains undefined.
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