Manuel Quintana-Díaz1,2,3, Sara Fabra-Cadenas1,3, Susana Gómez-Ramírez4, Ana Martínez-Virto1,3, José A García-Erce3,5, Manuel Muñoz4. 1. Emergency Department, University Hospital La Paz, Madrid, Spain. 2. Intensive Care Unit, University Hospital La Paz, Madrid, Spain. 3. Emergency Medicine Research Group, Research Institute University Hospital La Paz (IdiPAZ), Madrid, Spain. 4. Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain. 5. Haematology and Haemotherapy Service, General Hospital San Jorge, Huesca, Spain.
Abstract
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. DISCUSSION: 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.
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. DISCUSSION: 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.
Authors: Michael Auerbach; John Adamson; Andreas Bircher; Christian Breymann; Steven Fishbane; Anat Gafter-Gvili; Christoph Gasche; Jeffrey Gilreath; Giuliano Grazzini; David Henry; Giancarlo Liumbruno; Francesco Locatelli; Iain Macdougall; Manuel Munoz; David Rampton; George Rodgers; Aryeh Shander Journal: Haematologica Date: 2015-05 Impact factor: 9.941
Authors: M Muñoz; S Gómez-Ramírez; S Kozek-Langeneker; A Shander; T Richards; J Pavía; H Kehlet; A G Acheson; C Evans; R Raobaikady; M Javidroozi; M Auerbach Journal: Br J Anaesth Date: 2015-07 Impact factor: 9.166
Authors: Manuel Quintana-Díaz; Raúl Muñoz-Romo; Susana Gómez-Ramírez; José Pavía; Alberto M Borobia; José A García-Erce; Manuel Muñoz Journal: Blood Transfus Date: 2017-01-24 Impact factor: 3.443
Authors: Manuel Quintana Díaz; Alberto M Borobia; José A García Erce; Charbel Maroun-Eid; Sara Fabra; Antonio Carcas; Jesus Frías; Manuel Muñoz Journal: Blood Transfus Date: 2016-07-07 Impact factor: 3.443
Authors: Manuel Muñoz; Susana Gómez-Ramírez; Martin Besser; José Pavía; Fernando Gomollón; Giancarlo M Liumbruno; Sunil Bhandari; Mercé Cladellas; Aryeh Shander; Michael Auerbach Journal: Blood Transfus Date: 2017-09 Impact factor: 3.443