Red blood cell transfusion after a global strategy for early detection and treatment of iron deficiency anemia: three-year results of a prospective observational study.

Abstract

Anemia is the main indication for red blood cell (RBC) transfusion and iron deficiency is the most prevalent, preventable, and treatable cause of anemia worldwide. We aimed to assess the impact of iron deficiency anemia (IDA) on RBC transfusion by means of a program for prevention, early detection, and treatment. A prospective observational study was conducted starting in 2014 after an intervention in clinical practice in Melilla, a peripheral city isolated by 207 km sea distance to nearest continental Spain. Recommendations were proposed for first-step diagnosis of iron deficiency in the laboratory, oral iron prevention and treatment in primary care, and intravenous iron complexes and RBC transfusion for hospital management. Reduction in RBC use for years 2014 to 2016 was the primary outcome, with the period 2010 to 2013 considered as baseline performance for statistical analysis. Compared to baseline, there was a significant (p < 0.05) increase in mean (±SD) yearly reference population (79,748 ± 3265 vs. 85,376 ± 781), ferritin assays (6980 ± 997 vs. 11,794 ± 1567), admissions (6768 ± 239 vs. 7629 ± 191), and subjects exposed to iron therapy (3975 ± 0.0 vs. 4667 ± 21 for oral, 54 ± 7 vs. 257 ± 109 for sucrose, and 128 ± 9 vs.176 ± 15 for carboxymaltose iron). Mean yearly number of RBC units transfused decreased (1622 ± 112 vs. 1434 ± 44; p = 0.043), with a mean reduction of 11.6% from baseline, or 21.4% when estimated by units transfused per 1000 admissions. Management of IDA is a target to avoid RBC transfusion, and awareness of this health problem should be among the first pillars for any patient blood management program.