Iron Deficiency Anemia Research Articles

8623 Atypical VHL Genetic Variant Causing Paraganglioma

Abstract Disclosure: G. Mangu: None. J.J. Faria Briceno: None. R. Yatavelli: None. Abstract: Pheochromocytomas and paragangliomas (PPGLs) are rare chromaffin cell tumors that originate from the adrenal medulla and extra-adrenal paraganglia respectively. Previous studies have shown that incidental PPGLs are seen in older patients with mild symptoms. They have lower levels of plasma catecholamines and lower incidence of malignancy than patients with nonincidental PPGLs. We report a case of an incidental paraganglioma in a young female with atypical pathogenic variant in the VHL gene which is known to cause familial erythrocytosis but NOT VHL syndrome or PPGL. Case Presentation: A 33-year-old African American female with no significant medical history presented to the emergency room with the chief complaint of right lower quadrant pain for 2 days, which started with her menstruation. The vitals were BP 128/67, pulse 67 and physical examination was unremarkable. CT showed a 4.0 x 3.0 cm heterogenous enhancing left adrenal mass and MRI with adrenal protocol revealed 3.4 x 3.1 cm mass consistent with pheochromocytoma. Labs revealed elevated plasma nor metanephrines and 24-hour urine normetanephrines were 1020 mcg. She was asymptomatic without hypertension, palpitations, or chest pain. She underwent laparoscopic left adrenalectomy after appropriate alpha blockade. The pathology report showed left periadrenal paraganglioma with immunohistochemistry staining significant for Carbonic anhydrase IX (CAIX) membranous expression which is mostly seen in paragangliomas associated with von Hippel-Lindau syndrome. Clinically, she did not have any stigmata for hereditary PPGL syndrome. Her genetic testing revealed a pathogenic heterozygous variant in the VHL gene, Exon 3, c.598C.T (pArg200Trp), which is a missense variant expected to disrupt VHL protein function. Although she has a germline mutation in VHL, it is not the garden variant which is associated with classic VHL syndrome. It has been reported to cause autosomal recessive erythrocytosis but not PPGL. Conclusion: The pathogenic heterozygous variant in VHL gene, Exon 3, c.598C.T (pArg200Trp) is known to cause autosomal recessive familial erythrocytosis type 2 in the Chuvash population, termed as Chuvash Polycythemia. Our patient did not have polycythemia but had iron deficiency anemia from menorrhagia. Several studies have reported that this variant does not cause VHL syndrome, however it has been reported in a single family with VHL syndrome but WITHOUT pheochromocytoma. To our knowledge, incidental adrenergic paraganglioma associated with this mutation has not been reported in the literature. Presentation: 6/3/2024

6572 Acute Adrenal Crisis Secondary To Undiagnosed Addison's Disease

Abstract Disclosure: J.M. Deirmenjian: None. H. Nickowitz: None. T. Kavafyan: None. Addison’s disease, also known as primary adrenal insufficiency, is when the adrenal gland has a defect in making cortisol. Signs and symptoms of Addison’s disease include nausea, vomiting, diarrhea, fatigue, dizziness, hyperpigmentation, and mood changes. Acute Adrenal Crisis can occur as a result of Addison’s disease when patients experience acute physiologic stress such as acute illness. Patient is a 35- year-old woman with a PMHx of iron deficiency anemia presenting with intractable nausea and vomiting for 10 days and a single witnessed syncopal episode two days prior to presentation. She was also had intermittent dizziness. Patient initially presented to urgent care where she was found to be hyponatremic and then was sent to the ED. She had no seizure like activity or rashes prior to admission. On initial physical exam, her skin was warm and dry with skin discoloration and hyperpigmentation. She was awake, alert, and oriented to person, place, time, and situation. Patient had no neurological deficits and no lateral or vertical nystagmus on initial assessment. On admission, patient was hyponatremic to 114 mEq/L, potassium was 5.0 mEq/L, and glucose level was 79 mg/dL. Despite receiving a 500 cc NS bolus, 1L NS bolus, 25 grams of albumin, and D5-0.45 NS at 50 cc/hr, the hyponatremia was difficult to correct. Her sodium initially corrected to 120 mEq/L but the sodium later decreased to 117 mEq/L. The morning after admission, patient became hypotensive and hypoglycemic. Random cortisol was measured and found to be 2.2 mcg/dL, raising concern for acute adrenal crisis as a result of undiagnosed Addison’s Disease. ACTH level was 17 pg/mL. Endocrinology was consulted and she was treated with IV 100 mg Hydrocortisone in addition to IV hydrocortisone 50 mg IV q6h. Patient was able to be transitioned to PO hydrocortisone 15 mg qAM and 5 mg qPM and was started on PO fludrocortisone 0.1 mg daily. On day of discharge, sodium improved to 127 mEq/L. CT Abdomen with contrast was completed to evaluate the adrenal glands and it showed a normal appearance of the adrenal glands. The etiology of the patient’s acute adrenal crisis was secondary to undiagnosed Addison’s Disease. It is interesting to note that patient was not hypoglycemic on admission but later became hypoglycemic during her hospital course. Adrenal crisis is a possible fatal complication of undiagnosed Addison’s disease. Therefore, a possible Addison’s Disease diagnosis is important to consider when patients are presenting with symptoms such as nausea, vomiting, dizziness, and electrolyte derangements including hyponatremia. If patient’s present with hyponatremia, ruling out possible adrenal insufficiency by checking a cortisol level may change the course of patient’s care. After discharge, she was able to establish care with Endocrinology and remain stable on treatment with PO hydrocortisone and PO fludrocortisone. Presentation: 6/3/2024

6970 Severe Symptomatic Hypophosphatemia After Intravenous Iron Therapy: An Under-recognized Adverse Reaction

Abstract Disclosure: A. Morvant: None. O. Olajide: None. Introduction: Iron deficiency is a common condition that is often treated with intravenous preparations of iron supplementation. It has been documented in the literature that ferric carboxymaltose is the form of intravenous iron supplementation that is associated with the highest incidence of hypophosphatemia, when compared to other formulations of intravenous iron therapy. This case highlights a severe case of hypophosphatemia after ferric carboxymaltose therapy that led to multiple hospitalizations and required several months of oral and intravenous phosphorus repletion. Clinical Case A 36-year-old woman presented to the ED with severe diffuse arthralgias, generalized muscle weakness, and fatigue. Laboratory analysis revealed the following: phosphorus 1.2 mg/dL (2.3-4.7 mg/dL), 25-hydroxyvitamin D 13 ng/mL (25-80 ng/mL), parathyroid hormone 220 pg/mL (16-77 pg/mL), and calcium 8.5 mg/dL (8.4-10.5 mg/dL). She was admitted and started on intravenous and oral phosphorus repletion as well as oral ergocalciferol. She was subsequently discharged home on oral phosphorus and ergocalciferol supplementation, with a phosphorus level of 1.8 mg/dL. She was readmitted one day later with persistent arthralgias, myalgias, and severe fatigue, and found to have a phosphorus level of 1.1 mg/dL. Additional laboratory studies revealed the following: FGF23 41 pg/mL (<59 pg/mL) and 24-hour urine phosphorus 2191 mg/24hr (400-1300 mg/24hr). The patient notably had a history of chronic severe iron deficiency anemia due to menorrhagia and had been treated with intravenous iron sucrose infusions 7 months prior to her presentation. Due to adverse reactions to iron sucrose, this was switched to ferric carboxymaltose, and she had received two doses; one month and two weeks prior to her initial presentation. She was treated again with intravenous and oral phosphorus repletion and ergocalciferol and discharged after two weeks on oral phosphorus and ergocalciferol as well as thrice-weekly intravenous phosphorus infusions in the outpatient setting. She continued intravenous phosphorus infusions for about three months, and this was subsequently discontinued without recurrent hypophosphatemia. She is currently on low doses of oral phosphorus with normophosphatemia. Conclusion: Intravenous ferric carboxymaltose therapy can lead to severe and long-lasting, treatment-resistant hypophosphatemia due to increased urinary phosphate excretion. An increased awareness about this is needed by clinicians in treating patients who receive ferric carboxymaltose and monitoring phosphorous levels is crucial.

Study on Prevalence of Iron Deficiency Anaemia in Children of 6 Months - 12 Years of Age in Barabanki District, Uttar Pradesh

Study on Prevalence of Iron Deficiency Anaemia in Children of 6 Months - 12 Years of Age in Barabanki District, Uttar Pradesh

Iron status, anemia, and birth outcomes among pregnant women in urban Bloemfontein, South Africa: the NuEMI study

BackgroundDespite routine iron supplementation for pregnant women in South Africa, anaemia and iron deficiency (ID) in pregnancy remain a public health concern.ObjectiveTo determine the associations between iron status and birth outcomes of pregnant women attending antenatal clinic at a regional hospital in Bloemfontein.MethodsIn this cross-sectional study of 427 pregnant women, blood was taken to analyze biomarkers of anaemia (haemoglobin), iron status (ferritin and soluble transferrin receptor) and inflammation (C-reactive protein and α-1-acid glycoprotein). A questionnaire was used to collect information about birth outcomes (birth weight and gestational age at birth), HIV exposure, sociodemographics, iron supplement intake, and maternal dietary iron intake using a validated quantified food frequency questionnaire.ResultsThe median (Q1, Q3) weeks of gestation of participants was 32 (26, 36) at enrolment. Anaemia, iron deficiency (ID), ID anaemia (IDA) and ID erythropoiesis (IDE) were present in 42%, 31%, 19% and 9.8% of participants, respectively. Median (Q1, Q3) dietary and supplemental iron intake during pregnancy was 16.8 (12.7, 20.5) mg/d and 65 (65, 65) mg/d, respectively. The median (max-min) total iron intake (diet and supplements) was 81 (8.8-101.8) mg/d, with 88% of participants having a daily intake above the tolerable upper intake level of 45 mg/d. No significant associations of anaemia and iron status with low birth weight and prematurity were observed. However, infants born to participants in the third hemoglobin (Hb) quartile (Hb > 11.3–12.2 g/dL) had a shorter gestation by 1 week than those in the fourth Hb quartile (Hb > 12.2 g/dL) (p = 0.009). Compared to pregnant women without HIV, women with HIV had increased odds of being anaemic (OR:2.14, 95%CI: 1.41, 3.247), having ID (OR:2.19, 95%CI: 1.42, 3.37), IDA (OR:2.23, 95%CI: 1.36, 3.67), IDE (OR:2.22, 95%CI: 1.16, 4.22) and delivering prematurely (OR:2.39, 95%CI: 1.01, 5.64).ConclusionIn conclusion, anaemia, ID, and IDA were prevalent in this sample of pregnant women, despite the reported intake of prescribed iron supplements, with HIV-infected participants more likely to be iron deficient and anaemic. Research focusing on the best formulation and dosage of iron supplementation to enhance iron absorption and status, and compliance to supplementation is recommended, especially for those living with HIV infection.Graphical

Expression of Serum and Salivary Levels of Obestatin in Periodontitis Patients with and without Iron Deficiency Anemia

Expression of Serum and Salivary Levels of Obestatin in Periodontitis Patients with and without Iron Deficiency Anemia

A-159 Re-evaluating Ferritin Cutoffs for the Diagnosis of Iron Deficiency and Iron Deficiency Anemia

Abstract Background Iron deficiency (ID) is the most common nutrient deficiency in the world and iron deficiency anemia (IDA) is estimated to affect 1.24 billion people. Serum ferritin is an iron storage protein commonly used as a biomarker for ID and IDA. The ferritin lower limit of normal (LLN) defined in many clinical laboratories is lower than evidence-based cutoffs and may not detect ID and IDA with adequate sensitivity, particularly when sex-based reference intervals (RIs) are used. This may be due in part to the use of asymptomatic, iron-depleted individuals for RI studies. Recent efforts have been made to increase the LLN for ferritin to at least 30 ng/mL and re-evaluate sex based RIs to improve diagnosis of ID and IDA. In this study, we aimed to investigate LLN ferritin cutoffs for ID and IDA in our patient population. Methods Patient data from June 2022-May 2023 were collected with approval from the Institutional Review Board (IRB), including age, sex, and values for ferritin, iron, transferrin saturation, and hemoglobin. Patients were classified as iron replete (IR), ID, or IDA based on measurements for iron, transferrin saturation, and hemoglobin. IR patients were defined as having iron and transferrin saturation values within current RIs, while those below the cutoff were grouped as ID. ID and IDA were further classified based on hemoglobin values. A range of ferritin concentrations between 1 and 100 ng/mL were used to calculate true and false positive rates (TPR and FPR) and diagnostic accuracy (DA). Receiver operator characteristic (ROC) curve and J index analysis were used to define optimal ferritin cutoffs for ID and IDA. Results Data from 26,455 patients (65% female) were used in this study. Conclusions These findings highlight the need to re-examine ferritin RIs in the context of ID/IDA, especially for those patients assigned female at birth.

A-100 Clinical Utility of Measuring Creatine Concentration in Erythrocyte

Abstract Background Shortened erythrocyte lifespan characterizes hemolytic anemia and impacts HbA1c values. Recently, erythrocyte creatine concentration (EC) measurement emerged as a new method to assess erythrocyte lifespan. However, literature reports conflicting findings regarding the association between erythrocyte lifespan and EC concentration. In our study, we noted low EC concentrations in renal diseases, typically linked to short erythrocyte lifespan, while iron deficiency anemia exhibited high EC concentrations. This contradicts established relationships, prompting a reevaluation of EC concentration assessment. The aim is to evaluate the clinical utility of EC concentration measurements by correlating them with various clinical parameters, including hematopoietic status. Methods EC concentrations were measured in 522 subjects (252 females, 270 males) aged 19 to 95 at Kawasaki Medical School Hospital. Medical records and laboratory test results from around one month before and after blood collection were used to create a database. Box-and-whisker plots illustrated EC concentration distribution for each disease, and scatter plots compared EC concentrations with laboratory parameters. Results EC concentrations were lower in renal diseases like Diabetes and Chronic Kidney Disease but higher in iron deficiency anemia (Fig. 1). Moreover, EC concentrations rose as hemoglobin concentrations declined, unaffected by CKD grade (Fig. 2). Conclusions While conventionally, high EC concentrations imply a short erythrocyte lifespan, our study noted the opposite trend. EC concentrations might not indicate erythrocyte lifespan but instead reflect hemoglobin synthesis. Investigating EC concentration's relationship with factors like iron and vitamin B12 involved in hemoglobin synthesis may unveil new clinical applications.

A-115 Iron assay improvement: The need for thiourea addition in Ferene/Ferrozine reagent cartridge

Abstract Background Iron assay is often ordered along with ferritin, transferrin, and iron binding capacity in patients suspected of having iron deficiency anemia or iron overload. A ferene/Ferrozine chromogen-based iron assay is more common in College of American Pathology accredited laboratories across U.S. Recently, a product recall/field safety notice was issued by a major manufacturer for several lots of ferene based iron reagent due to unacceptable positive bias in patient iron results. However, the reason(s) underlying this positive bias was not provided. In this report, we investigated the possible causes for the recall of specific lots of iron assay reagents. Methods The performance of 2 lots of recalled iron test kits was compared against 2 good lots (Sentinel Diagnostics) on the Alinity c analyzer utilizing approved calibrator lots, quality control (QC) materials (Bio-Rad Laboratories), and excess/leftover de-identified patient samples. Spectral scan (in the visible wavelength) of good and recalled lots of reagents, R1 and R2 was performed on the Tecan microplate reader. Trace elements in R1 and R2 reagents were estimated with Quantitative Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Spiking experiments in calibrator, discarded patient samples, and reagents were undertaken to further elucidate the cause and prevention of positive bias seen with recalled reagent lots. Graphs and statistical analysis were generated using Graphpad prism 10.1. Results Iron levels in QC materials and de-identified patient samples (n=42) tested with 2 recalled lot of reagents on Alinity c analyzer showed a positive bias of 15-36% compared to unimpacted lots of reagents. Calibrator and blank absorbance of recalled lots was much higher than the unimpacted lots. Percentage change in the basal absorbance of recalled vs unimpacted R2 reagent measured from 500 to 600 nm in 25 nm increments and corrected to 700 nm ranged from 150 to 250%. No such changes were noted with both R1 reagents. Interestingly, ICP-MS heavy metal panel analysis revealed that R2 reagent of the recalled lots had unanticipated presence of Cu (∼22 υg/dL) and lead (7.5 υg/L), which was not present in R1 reagents. Increased concentrations of Cu spiking (100, 200, and 400 υγ/dL) in R2 reagent from recalled lots discernibly increased the Cal Factor values as well as patient iron results relative to unspiked reagent. Further, the presence of Cu over time deteriorated the accuracy of R2 reagent reflecting on very high rise in Cal Factor and patient iron values. Interestingly, TU addition to R2 reagent from unimpacted lot prevented the Cu-induced spurious rise in Cal Factor and iron measurements in the patient samples. Further, TU exhibited sustained preventive effect on Cu-induced iron measurement changes over time. Conclusions Based on our investigation, we conclude that copper contamination of R2 reagent is the possible cause for the positive bias in the recalled iron assay reagent lots. We recommend the addition of TU to Ferene containing R2 reagent pack as a simple and effective step to prevent Cu-induced false elevation in iron values.

Iron Treatment in Patients with Iron Deficiency Before and After Metabolic and Bariatric Surgery: A Narrative Review.

Iron is an essential nutrient in living organisms with multiple vital functions. Iron deficiency (ID) can cause long term health consequences beyond iron deficiency anemia (IDA). The high prevalence of ID and its long-term effects in patients with obesity and after metabolic and bariatric surgery (MBS) is recognized. Nevertheless, there is limited knowledge of the optimal route or dose for treatment of patients with obesity and post-MBS, and an evidence-based universal guideline for prevention and treatment of ID in short- and long-term post-MBS (PMBS) is not yet available. ID in the general population is currently treated with oral or parenteral iron, where oral iron treatment is considered the preferred option with parenteral iron as a second-line treatment in case there is intolerance or lack of response to oral iron. In patients with obesity with chronic low-grade inflammation and PMBS patients with altered gut anatomy and function, there are also alterations in the bioavailability and higher risks of side effects of available oral irons. The conclusions of current studies exploring effective treatment of iron deficiency in this population have been inconsistent and further well-planned randomized and prospective studies are needed. This is a narrative review of the literature on the available treatment options and strategies for treatment of ID in PMBS patients to recognize the knowledge gaps and provides topics of future research.

EVALUATING THE IRON DEFICIENCY ANEMIA IN TYPE-II DIABETIC PATIENTS TAKING METFORMIN AND ITS ASSOCIATION WITH OXIDATIVE STRESS

Iron deficiency anemia (IDA) is one of the most common nutritional disorders worldwide, affecting individuals across various demographic groups. Objective: The main objective of the study is to find iron deficiency anemia in type-II diabetic patients taking metformin and its association with oxidative stress. Methods: This cross-sectional observational study was conducted at the outpatient department (OPD) of the Medical Unit at Khawaja Muhammad Safdar Medical College, Sialkot, during the study period from 1st January 2024 to 31st June 2024. Data were collected from 285 patients diagnosed with type 2 diabetes mellitus (T2DM) who were receiving metformin therapy. Patients were divided into two groups—Group A (patients with IDA) and Group B (patients without IDA)—and the oxidative stress markers were compared between these two groups. Results: Data were collected from 285 patients with 92 in Group A (IDA) and 193 in Group B (Non-IDA). The mean age of participants was 57.6 ± 9.4 years, with no significant difference between Group A (58.2 ± 9.1) and Group B (57.3 ± 9.6) (p = 0.422). Gender distribution was similar between groups (p = 0.601). The mean duration of diabetes was also comparable between the groups (8.3 ± 3.4 years in Group A and 8.0 ± 3.1 years in Group B, p = 0.572). However, HbA1c levels were significantly higher in Group A (8.3 ± 1.6%) compared to Group B (7.5 ± 1.3%) (p = 0.012), indicating poorer glycemic control in the IDA group. Conclusion: This study concludes that iron deficiency anemia (IDA) is prevalent among type 2 diabetic patients on metformin therapy, affecting approximately one-third of the study population. Additionally, there is a significant association between IDA and increased oxidative stress, as evidenced by elevated levels of malondialdehyde (MDA) and reduced antioxidant enzymes (SOD and GPx) in patients with anemia.

Evaluating The Diagnostic Value Of Red Cell Distribution Width (RDW) In Identifying Iron Deficiency Anemia: A Retrospective Analysis

Background: Iron Deficiency Anemia (IDA) is the most prevalent form of anemia globally, with a significant impact on public health, especially in low-resource settings like Bangladesh. Accurate and early diagnosis of IDA is essential for effective treatment. Red Cell Distribution Width (RDW) has emerged as a promising, accessible diagnostic tool for IDA, yet its utility remains underexplored in this context. Methods: This retrospective cross-sectional study, conducted between July 2022 and July 2024 at Addin Barrister Rafique-ul Huq Hospital in Bangladesh, included 106 patients diagnosed with microcytic hypochromic anemia. Key hematological parameters, including hemoglobin, RBC count, MCV, and RDW, were analyzed. Correlation analyses were performed to assess the relationships between RDW and other parameters such as hemoglobin, MCV, RBC count, and Erythrocyte Sedimentation Rate (ESR). Results: RDW was elevated (>14.5%) in 92.45% of the participants, with a mean RDW of 17.59±3.33%. Significant negative correlations were observed between RDW and hemoglobin (r = -0.435, p < 0.001) and between RDW and MCV (r = -0.664, p < 0.001). RDW showed positive correlations with RBC count (r = 0.315, p = 0.001) and ESR (r = 0.225, p = 0.041). The study confirmed RDW’s strong diagnostic value in distinguishing IDA, particularly in resource-constrained settings. Conclusion: RDW, combined with other hematological parameters, is a sensitive and reliable marker for diagnosing IDA. Its incorporation into routine diagnostic protocols could significantly enhance IDA detection and management in low-resource settings like Bangladesh.

High internal phase Pickering emulsions co-loaded with astaxanthin and ferrous gluconate improve iron deficiency anemia in mice and their applications in 3D printing

Iron deficiency anemia (IDA) is a prevalent and serious nutritional health issue that can be mitigated through dietary iron supplementation. However, only ferrous ions, prone to oxidation, can be absorbed in the gastrointestinal tract. In the current work, the effects of high internal phase Pickering emulsions (HIPPEs) co-loaded with astaxanthin (ASTA) and ferrous gluconate on Fe2+ oxidation, IDA management, and their 3D printing performance were investigated. The results demonstrated that the HIPPEs co-loaded with ASTA and ferrous gluconate effectively reduced the oxidation rate of Fe2+ during storage. Animal studies also revealed that HIPPE co-loaded with ASTA and ferrous gluconate had a therapeutic effect on IDA symptoms in mice. HIPPE co-loaded with ASTA and 400 mg/L ferrous gluconate demonstrated superior efficacy in restoring hemoglobin (Hb) levels, organ coefficients, and histological parameters in mice with IDA. Moreover, the evaluation of the adaptability of HIPPEs co-loaded with ASTA and ferrous gluconate for food 3D printing indicated a slight reduction in printing resolution. Overall printing performance was found to be acceptable and satisfactory. Co-loading ASTA and ferrous gluconate in HIPPEs offers an efficient way to address the oxidation challenge of ferrous ion supplementation, enabling customization and flexibility in the production of iron-fortified foods to mitigate IDA.

Comparison of the Anaemia and Transfusion Rates of Pregnant Women Treated with Intravenous versus Oral Iron in the Third Trimester.

To evaluate and compare the blood transfusion requirements during delivery in third-trimester pregnant women with iron deficiency anaemia (IDA) who were treated with intravenous (IV) ferric carboxymaltose (FCM) versus those treated with oral iron supplementation. Comparative study. Place and Duration of the Study: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkiye, from January 2017 to December 2022. Pregnant women with haemoglobin (Hb) levels <10 g/dL in their third trimester were included. One group (n = 50) received IV FCM, while the other group (n = 96) received oral iron therapy. Key outcome measures included Hb levels at delivery and the need for a postpartum blood transfusion. Inclusion criteria were third-trimester pregnancy with IDA, and exclusion criteria included haematological or chronic systemic diseases and high-risk pregnancies. The mean initial Hb levels in the third trimester of pregnancy in the FCM group and oral iron group were 8.31 ± 0.96 g/dL and 9.29 ± 1.20 g/dL, respectively (p <0.001). The mean Hb levels in the delivery room were 11.09 ± 1.38 and 9.44 ± 1.16 g/dL, respectively (p <0.001). The rates of postpartum erythrocyte transfusion requirement were 6% (n = 3) and 18.75% (n = 18), respectively (p = 0.037). IV FCM administration to pregnant patients with IDA during the third trimester was found to be more effective than oral iron treatment in reducing blood transfusion rates. Anaemia, Ferric carboxymaltose, Pregnancy, Iron deficiency, Intravenous iron.

Enhancing referral practices: A bariatric department's education initiative to reduce unnecessary referrals to hematology oncology.

82 Background: Bariatric surgery patients face an elevated risk of iron deficiency anemia. Referrals from the Bariatric department to Hematology Oncology for work up of these anemias strain clinic resources and delay timely care for cancer patients. We initiated a targeted education program to reduce unnecessary referrals from the Bariatric department to Hematology Oncology by raising awareness among staff about appropriate referral criteria. Methods: We developed a curriculum highlighting the differences between symptoms of bariatric surgery complications and hematologic malignancies. Interactive training sessions were held with Bariatric department staff, supplemented by informational materials. Case studies and real-world examples reinforced understanding and decision-making. Staff were also educated on managing iron deficiency anemia internally. Referral rates were tracked before and after the intervention. Results: Baseline data were collected from July 2023 to November 2023, showing an average of 17 referrals per month (85 total over 5 months). The educational initiative included three sessions in December 2023 on anemia management and referral criteria. These sessions highlighted the distinction between symptoms of bariatric complications and hematologic malignancies, as well as education to the bariatric surgery providers on management of hematologic diagnoses resulting from bariatric surgery. Post-intervention data from January 2024 to May 2024 showed a substantial reduction in referrals for bariatric-related iron deficiency anemias to an average of 4.4 referrals per month (22 total over 5 months), indicating a 74% reduction. Improved internal management of iron deficiency anemia contributed to this outcome. The percentage of cancer patients receiving a consult within 7 days of referral contemporaneously improved from 85.7% to 88.1%, indicating improved access to oncology care. Conclusions: The educational intervention significantly reduced unnecessary referrals from the Bariatric department to Hematology Oncology, improving access for cancer patients. Empowering staff with the knowledge to make informed referral decisions and manage common hematologic issues internally improved patient care and clinic efficiency, reducing healthcare costs and patient burden in both departments.

S1021 A Retrospective Review: The Use of Fecal Occult Blood Testing for Evaluation of Acute/Chronic Blood Loss and Iron Deficiency Anemia Despite Secondary Diagnoses

S1021 A Retrospective Review: The Use of Fecal Occult Blood Testing for Evaluation of Acute/Chronic Blood Loss and Iron Deficiency Anemia Despite Secondary Diagnoses

S2869 The Importance of Early Diagnosis in a Patient With Macrocephaly and Iron Deficiency Anemia: A Case of Cowden Syndrome

S2869 The Importance of Early Diagnosis in a Patient With Macrocephaly and Iron Deficiency Anemia: A Case of Cowden Syndrome

S2913 Chronic Left Lower Quadrant Pain and Iron Deficiency Anemia in a Young Lady Mimicking a Colonic Endometrioma: Consider Cavernous Hemangioma of the Sigmoid

S2913 Chronic Left Lower Quadrant Pain and Iron Deficiency Anemia in a Young Lady Mimicking a Colonic Endometrioma: Consider Cavernous Hemangioma of the Sigmoid

S2207 Perspectives From Black Individuals on Iron Deficiency Anemia and Development of a Patient-Directed Infographic to Reduce Disparities in Evaluation and Management

S2207 Perspectives From Black Individuals on Iron Deficiency Anemia and Development of a Patient-Directed Infographic to Reduce Disparities in Evaluation and Management

S5043 Gastric Metastasis From Renal Cell Carcinoma Presenting as Iron Deficiency Anemia: A Case Report

S5043 Gastric Metastasis From Renal Cell Carcinoma Presenting as Iron Deficiency Anemia: A Case Report