A fast-track anaemia clinic in the Emergency Department: feasibility and efficacy of intravenous iron administration for treating sub-acute iron deficiency anaemia |
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Authors: | Manuel Quintana-Díaz Sara Fabra-Cadenas Susana Gómez-Ramírez Ana Martínez-Virto José A García-Erce Manuel Mu?oz |
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Institution: | 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 |
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Abstract: | BackgroundClinically 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 methodsFrom 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.ResultsTwo 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.DiscussionOur 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. |
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Keywords: | hospital emergency department sub-acute anaemia fast-track anaemia clinic intravenous iron transfusion |
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