A fast-track anaemia clinic in the Emergency Department: feasibility and efficacy of intravenous iron administration for treating sub-acute iron deficiency anaemia

• Published in: Blood transfusion = Trasfusione del sangue Vol. 14; no. 2; pp. 126 - 133
• Main Authors: Quintana-Díaz, Manuel, Fabra-Cadenas, Sara, Gómez-Ramírez, Susana, Martínez-Virto, Ana, García-Erce, José A, Muñoz, Manuel
• Format: Journal Article
• Language: English
• Published: Italy Edizioni SIMTI - SIMTI Servizi Srl 01.03.2016
• Subjects: Administration, Intravenous; Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency - blood; Anemia, Iron-Deficiency - drug therapy; Emergency Service, Hospital; Female; Follow-Up Studies; Humans; Iron - administration & dosage; Iron - blood; Male; Middle Aged; Original; Retrospective Studies
• ISSN: 1723-2007
• DOI: 10.2450/2015.0176-15

Clinically significant anaemia, requiring red blood cell transfusions, is frequently observed in Emergency Departments (ED). To optimise blood product use, we developed a clinical protocol for the management of iron-deficiency anaemia in a fast-track anaemia clinic within the ED. From November 2010 to January 2014, patients presenting with sub-acute, moderate-to-severe anaemia (haemoglobin [Hb] <11 g/dL) and confirmed or suspected iron deficiency were referred to the fast-track anaemia clinic. Those with absolute or functional iron deficiency were given intravenous (IV) ferric carboxymaltose 500-1,000 mg/week and were reassessed 4 weeks after receiving the total iron dose. The primary study outcome was the haematological response (Hb≥12 g/dL and/or Hb increment ≥2 g/dL). Changes in blood and iron parameters, transfusion rates and IV iron-related adverse drug effects were secondary outcomes. Two hundred and two anaemic patients with iron deficiency (150 women/52 men; mean age, 64 years) were managed in the fast-track anaemia clinic, and received a median IV iron dose of 1,500 mg (1,000-2,000 mg). Gastro-intestinal (44%) or gynaecological (26%) bleeding was the most frequent cause of the anaemia. At follow-up (183 patients), the mean Hb increment was 3.9±2.2 g/dL; 84% of patients were classified as responders and blood and iron parameters normalised in 90%. During follow-up, 35 (17%) patients needed transfusions (2 [range: 1-3] units per patient) because they had low Hb levels, symptoms of anaemia and/or were at risk. Eight mild and one moderate, self-limited adverse drug effects were witnessed. Our data support the feasibility of a clinical protocol for management of sub-acute anaemia with IV iron in the ED. IV iron was efficacious, safe and well tolerated. Early management of anaemia will improve the use of blood products in the ED.