PTU-115 Intravenous iron is effective in reducing the need for blood transfusion in acute medical settings

Abstract

Introduction Blood transfusions are necessary for patients with significant symptomatic anaemia in acute medical settings. However, the increasing use and availability of intravenous (IV) iron in these patients may reduce the frequency of blood transfusion and its attendant risks. Our aim was to evaluate this. Methods The following IT systems were interrogated: Electronic Patient Record (EPR), Integrated Clinical Environment (ICE) (requests and results) and E-Prescribing and Medicines Administration (EPMA). A list of inpatient episodes was generated for the years 2014–2016 whose discharge summaries included one of the following coded diagnoses: anaemia, menorrhagia or gastrointestinal bleeding (GIB) (using respective anatomical terms). These records were then reviewed to identify those who received packed red cell (PRC) transfusions or IV iron preparations and their respective doses. Those who did not receive PRC transfusions or were transfused as outpatients or a semi-elective day case setting were excluded. Results 321 of 770 episodes received PRC transfusion. The overall units transfused were: 468 in 2014, 334 in 2015 and 309 in 2016; equating to an equivalent of 93,600 mg, 66,800 mg and 61,800 mg of elemental iron (200 mg/unit). For those coded with anaemia (n=137), there was a significant reduction in the mean PRCs transfused in 2016 compared to 2014 (figure 1). With regards to IV iron preparations see table below. Using the same sample population as Graph 1, a significant increase in the administration of IV iron preparations is evident in 2016 compared to 2014 (Graph 2). Conclusion Over three consecutive years, this retrospective study demonstrates an overall reduction in the number of PRC transfusions given to inpatients with anaemia, GIB, or menorrhagia, and an increase in IV iron (mg) administered. Furthermore, for patients coded with anaemia in 2014 and 2016, the data indicates a significant change in administration of both PRCs and IV iron. This suggests that the increased utilisation of IV iron contributes to a reduction in PRC transfusions, thereby lowering the potential risks associated with delivering blood products. This is particularly evident in those patients with anaemia as opposed to bleeding. Other reasons for the decrease in PRC transfusions may include the promulgation of a lower haemoglobin level at which to transfuse and the increased availability of elective day-case management of patients requiring transfusion.