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Comment & Response
October 3, 2017

Ferric Carboxymaltose to Treat Isovolemic Anemia—Reply

Author Affiliations
  • 1Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
  • 2Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
JAMA. 2017;318(13):1281-1282. doi:10.1001/jama.2017.11651

In Reply Drs Yu and Li were concerned that the results of the Ferric Carboxymaltose for Acute Isovolemic Anemia Following Gastrectomy (FAIRY) trial may have been skewed because patients with other causes of anemia were not excluded. Limited data on the reversal of certain types of anemia (such as sickle cell and HIV/AIDS-induced anemias) with intravenous iron demonstrate the importance of excluding such patient populations. However, 3 points ameliorate this concern. First, the exclusion criteria did eliminate patients with anemia induced by chronic, inherited, or severe conditions. Among other specifications, patients with concurrent medical conditions that jeopardized health, active infection or inflammation, or an American Society of Anesthesiologist (ASA) score greater than 3 were excluded from the study. Second, the prevalence of other anemia types that may have been overlooked by the exclusion criteria is small and should have been distributed equally in both groups. A study that evaluated the incidence and etiology of postgastrectomy anemia in 161 patients with gastric cancer found that non–iron-related causes of anemia—such as megaloblastic and vitamin B12 deficiency anemias—were rare.1

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