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All data generated or analysed during this study are included in this published article and its supplementary information files. Allogeneic red blood cell RBC transfusions remain the mainstay of treatment for anaemia but are associated with risks and are costly. Our objective was to assess the efficacy and safety of iron supplementation by any route, in anaemic patients in adult ICUs. Primary outcomes were red blood cell transfusions and mean haemoglobin concentration.
Secondary outcomes included mortality, infection, ICU and hospital length of stay, mean difference MD in iron biomarkers, health-related quality of life and adverse events. There was no difference in allogeneic RBC transfusion requirements relative risk 0. There was no difference in secondary outcomes of mortality, in-hospital infection, or length of stay.
Risk of bias was generally low although three trials had high risk of attrition bias; only one trial had low risk of bias across all domains. Iron supplementation does not reduce RBC transfusion requirements in critically ill adults, but there is considerable heterogeneity between trials in study design, nature of interventions, and outcomes.
Well-designed trials are needed to investigate the optimal iron dosing regimens and strategies to identify which patients are most likely to benefit from iron, together with patient-focused outcomes. Registered 2 March The online version of this article doi: Anaemia is common in critically ill patients and is associated with adverse outcomes [ 1 , 2 ].
The implementation of restrictive red cell transfusion policies is likely to compound the observed high prevalence of anaemia [ 5 ]. Allogeneic red blood cell RBC transfusion has been the mainstay of treatment for critical illness anaemia, although studies suggest that patients who receive allogeneic RBC transfusion are at increased risk of mortality, ischaemic complications, delayed wound healing, multi-organ dysfunction and increased length of stay [ 6 — 9 ].