Screening For Iron Deficiency Research Articles

Associations of iron deficiency and depressive symptoms among young adult males and Females: NHANES 2017 to 2020

Depression is one of the most prevalent mental health conditions throughout the lifespan. Notable differences in the prevalence of depression among females and males arise during adolescence and may peak during young adulthood. Since iron deficiency is a treatable condition that may contribute to depression, this topic among youth (18 to 25 years of age) needs to be further explored. Thus, our study examines the associations between three measures of iron (ferritin, serum iron, and transferrin saturation levels) with Patient Health Questionnaire-9 (PHQ-9) depressive symptoms and depression among young adult males and females using the National Health and Nutrition Examination Survey (NHANES) 2017–2020. Using multivariable Poisson and logistic regression models, adjusting for several demographic and clinical variables, we report 1) the prevalence of depression and 2) the associations between iron deficiency and depressive symptoms and depression among males and females. 917 participants were included in our study. More females (12.5 %) than males (6.8 %) had PHQ-9 depression. Males with ferritin (adjusted odds ratio [AOR] = 14.13, 95 % confidence interval [CI]: 1.51, 132.21), serum iron (AOR = 4.84, 95 % CI: 1.02, 22.92), and transferrin (AOR = 13.79, 95 % CI: 3.59, 53.06) deficiencies were at higher risk for depression, while females with ferritin deficiency (AOR = 0.34, 95 % CI: 0.11, 0.97) had a lower risk for depression. Our study highlights the need to focus on depression screening among young adults as well as risk factors for depression among this age group. Identifying risk factors and screening for iron deficiency, especially among females, should be considered as well.

The effect of iron deficiency on RV function in acute decompensated heart failure patients

Abstract Background Iron deficiency is a major problem in heart failure (HF) patients. Although the negative impact of iron deficiency on left ventricular (LV) function is known, the effect on right ventricle function (RV) is unclear. In this study we aimed to investigate the effect of iron deficiency on RV function. Material and Methods A hundred patients hospitalized with acute decompensated HF (ADHF) regardless of LV ejection fraction (LVEF) were included in our study. The primary outcome was association between iron deficiency and TAPSE, RVEF, RV FAC, and RV TDI S’. The secondary outcome was impact of iron deficiency on RV free wall global longitudinal strain (GLS). Results The mean age of study population was 70±10 years-old and 64% were male. The prevalence of hypertension (HT), diabetes mellitus (DM), ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) was 80%, 52%, 71%, and 18%, respectively. While the median LVEF was 35%, the proportion of patients with reduced EF (HFrEF), mildly-reduced EF (HFmrEF), and preserved EF (HFpEF) was 66%, 6% and 28%, respectively. On transthoracic echocardiography the median TAPSE was 16.4 mm, the mean FAC %37,2±7.8, the mean RV GLS %-16.4±5.1, and the mean RV TDI S’ was 10.6±2,9 cm per second. More than half of the patients (58%) had iron deficiency. There was no difference between patients with or without iron deficiency on neither demographics nor LVEF, RV FAC, RV TDI S’ and systolic pulmonary artery pressure (sPAP). The TAPSE (15.6 vs 17.2 mm, p = 0.05) and RV free wall GLS (-14.7% vs -18.2%, p = 0.005) was lower in HF patient with iron deficiency. Anemia was present in 56% of the patients and both TAPSE (15.3 vs 17.3 mm, p = 0.01) and RV GLS (-14.7% vs -18.6%, p = 0.01) were lower in patients with anemia. Conclusion RV dysfunction accompanying LV dysfunction adversely affects the prognosis. In patients with ADHF, iron deficiency causes subclinical RV dysfunction namely decreased RV free wall GLS before the right ventricle systolic functions parameters commonly used on echocardiography (RVEF, TAPSE, RV FAC, RV TDI S’) in daily practice deteriorate. In conclusion, screening for iron deficiency in HF patients facilitates early detection and treatment of iron deficiency which prevents RV dysfunction with iron replacement.Table 1Table 2

Abstract 17875: Quality Improvement Initiative to Improve Screening and Diagnosis Rates of Iron Deficiency in Patients Hospitalized for Acute Heart Failure With Reduced Ejection Fraction

Introduction: Despite being associated with reduced exercise capacity and poor quality of life in HFrEF, iron deficiency (ID) is underdiagnosed and undertreated. The 2022 ACC/AHA guidelines define ID in HFrEF as either a serum ferritin level < 100 ng/ml or 100-299 ng/ml with transferrin saturation (TSAT) <20 %. Treatment with IV iron is associated with a reduced risk of hospitalizations for HFrEF. A review of 20 inpatient acute HFrEF records revealed 10 had iron studies ordered, and 9 of them met criteria for ID, but only 1 patient received IV iron. Aim statement: To improve the testing rates for ID in hospitalized acute HFrEF patients at our hospital by 10% from January through March 2023. Methods: QI project included the implementation of an electronic health record (EHR) alert (Fig. 1) and resident education. The EHR alert was designed to be activated at the time of admission for patients with specific ICD codes for acute HFrEF to aid in ordering iron studies. A 20-minute educational session was delivered to residents, and handouts were provided to residents with reference material. Results: Pre-intervention data from January-December 2022 revealed a testing rate of 68% (154/194). ID was present in 58% (113/194). Post-intervention data from January 2023-March 2023 showed an improvement in the testing rate to 91% (67/73) and a concurrent increase in the diagnosis rate to 72% (53/73) (Fig. 2). Before discharge, 43.4% of patients (23/53) with ID received IV iron sucrose. Conclusion: Education and implementation of EHR alert were successful in increasing the testing rates for ID in acute HFrEF irrespective of anemia status. EHR tools should enhance sustainability compared to education alone.

Initial von Willebrand factor antigen values in adolescent females predict future values.

Diagnosing von Willebrand Disease (VWD) in adolescent females is challenging as menstruation and physiologic stress elevate von Willebrand factor (VWF) laboratory values. To develop a VWF prediction model for adolescent females based on initial VWF results. We identified female patients aged 9 to 21 years with any VWF laboratory test over a 5-year period (2017-2021) at any Texas Children's Hospital facility. Patient demographics, VWF testing, haemoglobin concentration, serum ferritin and site of clinical testing were collected (initial and subsequent laboratory evaluations). A Bayesian linear regression model was developed. Prediction intervals were analysed to identify thresholds for patients in whom repeat testing was unlikely to identify low VWF levels (<50%), consistent with VWD. A total of 6125 adolescent females underwent VWF testing; 1204 (19.7%) had repeat testing. Based on the prediction model, initial VWF antigen values of 80%, 90% and ≥100% carried a 92.6%, 96.6% and ≥98.0% probability of having repeat normal repeat VWF values, respectively.Subjects assessed in outpatient adolescent medicine or gynaecology clinics were more likely to have low VWF values compared to those assessed in the acute care setting (p<.001). Median presenting haemoglobin and serum ferritin were 12.4g/dL and 13ng/mL, respectively and were similar in those with normal versus low VWF antigen values. Repeat testing in adolescent females whose initial VWF antigen values are ≥90% is unlikely to identify additional patients with VWD. Iron deficiency screening should be performed in all adolescent females.

Ferric Carboxymaltose in Patients with Acute Decompensated Heart Failure and Iron Deficiency: A Real-Life Study.

Background: The correction of iron deficiency (ID) with ferric carboxymaltose (FCM) is a recommended intervention in heart failure (HF) with reduced ejection fraction. Our aim is to evaluate, in a real-life setting, the clinical significance of ID screening and FCM treatment in acute decompensated HF (ADHF). Methods: In a cohort of ADHF patients, the prevalence of ID and FCM administration were investigated. Among the 104 patients admitted for ADHF, in n = 90 (median age 84, 53.5% with preserved left ventricular ejection fraction-LVEF), a complete iron status evaluation was obtained. ID was detected in n = 73 (81.1%), 55 of whom were treated with in-hospital FCM. The target dose was reached in n = 13. Results: No significant differences were detected in terms of age, sex, comorbidities, or LVEF between the FCM-supplemented and -unsupplemented patients. During a median follow-up of 427 days (IQR 405-466) among the FCM-supplemented patients, only 14.5% received FCM after discharge; the mortality and rehospitalizations among FCM-supplemented and -unsupplemented patients were similar (p = ns). In a follow-up evaluation, ID was still present in 75.0% of the FCM-supplemented patients and in 69.2% of the unsupplemented patients (p = ns). Conclusions: In this real-life ADHF cohort, FCM was administered at lower-than-prescribed doses, thus having no impact on ID correction. The significance of our findings is that only achieving the target dose of FCM and pursuing outpatient treatment can correct ID and produce long-term clinical benefits.

Identification of women and girls with iron deficiency in the reproductive years.

Iron deficiency (ID) is the most common micronutrient deficiency in the world. It is of concern for women and girls of reproductive age as, despite frequent normalization, excessive menstrual blood loss and the iron demands associated with pregnancy increase the risk of developing an ID. Iron deficiency reduces health-related quality of life with symptoms of fatigue, heart palpitations, difficulty concentrating, and poor mental health. When left untreated, ID can escalate to iron deficiency anemia (IDA), where there is an insufficiency of red blood cells, or hemoglobin within these cells, to meet the bodily demands for oxygen transport. Substantial guidance on screening for ID can be found in specific at-risk groups, including pregnant women and patients with renal, cardiac, and inflammatory bowel disease. However, it was unclear whether guidance is available for women of reproductive age. We performed a literature search to explore the current recommendations for screening women of reproductive age for ID. While four manuscripts supportive of screening were found, no official guidance appears to exist regarding screening for this group. In line with the World Health Organization's 10 Principles of Screening, we present a case for ID screening in women and girls of reproductive age.

Optimizing diagnosis and treatment of iron deficiency and iron deficiency anemia in women and girls of reproductive age: Clinical opinion.

Iron deficiency (ID) is the world's most common disorder and one of the top five causes of years lived with disability. Whereas low serum ferritin is diagnostic of ID, ferritin-an acute phase reactant-may be elevated in inflammatory states and the first trimester of pregnancy even if ID exists. Consequently, in early pregnancy or chronic inflammation, percent transferrin saturation (TSAT) measurement is the best indicator of iron status. Unfortunately, current guidelines do not recommend routine screening for ID in either pregnant or nonpregnant women in the absence of anemia. This circumstance should be urgently reviewed based on available data. While oral formulations have long been the standard for iron replacement therapy and are widely available and inexpensive, oral iron is frequently associated with adverse gastrointestinal effects for the majority-a major reason for poor adherence, inadequate repletion, and persisting ID symptoms and sequellae. Although safe intravenous iron administration was introduced in the mid-1950s, formulations with cores binding the elemental iron more tightly became available in the 2000s, allowing complete and safe replacement, even in a single setting. Prospectively acquired neonatology evidence reports oral iron's failure to reach the developing fetus when the mother is iron deficient. Consequently, while oral iron remains frontline in the first trimester because of insufficient safety data for intravenous iron, the author recommends that the intravenous route should be the gold standard for second-trimester ID when hemoglobin concentrations are less than 10.5 g/dL and for all iron-deficient women in their third trimester.

Treatment of iron deficiency in patients scheduled for pancreatic surgery: implications for daily prehabilitation practice in pancreatic surgery

BackgroundPreoperative anemia is a frequent complication in pancreatic surgical patients, and it adversely affects morbidity, mortality, and postoperative red blood cell (RBC) transfusion rates. Iron deficiency (ID) is often the underlying cause of anemia and constitutes a modifiable risk factor.MethodsSingle-center, longitudinal prospective cohort study conducted between May 2019 and August 2022 at the University Medical Center Groningen in the Netherlands. Patients scheduled for pancreatic surgery were referred to the outpatient prehabilitation clinic for preoperative optimization of patient-related risk factors. Patients were screened for anemia (< 12.0 g/dL in women and < 13.0 g/dL in men) and ID (either absolute [ferritin < 30 µg/L] or functional [ferritin ≥ 30 µg/L + transferrin saturation < 20% + C-reactive protein > 5 mg/L]). Intravenous iron supplementation (IVIS) (1,000 mg ferric carboxymaltose) was administered to patients with ID at the discretion of the consulting internist. Pre- and postoperative hemoglobin (Hb) levels were assessed, and perioperative outcomes were compared between patients receiving IVIS (IVIS-group) or standard care (SC-group).ResultsFrom 164 screened patients, preoperative anemia was observed in 55 (33.5%) patients, and in 23 (41.8%) of these patients, ID was the underlying cause. In 21 patients, ID was present without concomitant anemia. Preoperative IVIS was administered to 25 patients, out of 44 patients with ID. Initial differences in mean Hb levels (g/dL) between the IVIS-group and SC-group at the outpatient clinic and one day prior to surgery (10.8 versus 13.2, p < 0.001, and 11.8 versus 13.4, p < 0.001, respectively) did not exist at discharge (10.6 versus 11.1, p = 0.13). Preoperative IVIS led to a significant increase in mean Hb levels (from 10.8 to 11.8, p = 0.03). Fewer SSI were observed in the IVIS-group (4% versus 25.9% in the SC-group, p = 0.02), which remained significant in multivariable regression analysis (OR 7.01 (1.68 – 49.75), p = 0.02).ConclusionID is prevalent in patients scheduled for pancreatic surgery and is amendable to preoperative correction. Preoperative IVIS increased Hb levels effectively and reduced postoperative SSI. Screening and correction of ID is an important element of preoperative care and should be a standard item in daily prehabilitation practice.

An Audit of Iron Deficiency in Hospitalised Heart Failure Patients: A Commonly Neglected Comorbidity.

Introduction Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF) and can significantly impact morbidity and mortality, regardless of the presence of anaemia. Aim This audit aimed to assess the current practice in diagnosing and assessing iron deficiency (ID) in hospitalised patients with heart failure and reduced ejection fraction (HFrEF). The primary goal was to determine the prevalence of ID in HF patients and the frequency of iron testing in those patients. Additionally, the secondary aims included evaluating the presence of anaemia, the length of hospital stay, and the adequacy of appropriate management for iron deficiency in this patient population. Methods A retrospective audit was conducted, reviewing data from patients admitted to St. Vincent University Hospital over a period of 4 months. Results Out of the 111 patients audited, only74% (82)had their iron status checked, and among those tested, 63% (52) met the criteria for iron deficiency according to the European Society of Cardiology (ESC).Additionally, 54% (28) of iron-deficient patients were also anaemic. Iron replacement was administered to 34 out of the 52 patients diagnosed with iron deficiency, accounting for 65% of the identified cases. The average duration of hospital stay for patients with iron deficiency was 13.8 days, while those without iron deficiency had a shorter mean length of stay of 11.2 days. However, it is important to note that the presence of co-morbidities and other confounding factors might have influenced these results. Conclusion Despite guideline recommendations, iron deficiency remains under-recognised and undertreated in clinicalpractice among heart failure patients. There is a crucial need for increased awareness, education, and practical guidance to improve the screening, diagnosis, and management of iron deficiency in hospitalised heart failure patients.

PRISM study-Pre-natal iron deficiency screening and management within an Australian regional centre.

Current Australian guidelines differ in their recommendations on optimal iron deficiency anaemia screening and management during pregnancy. A more active approach to screening and treatment of iron deficiency in pregnancy has been beneficial within a tertiary population. However, this approach has not been evaluated within a regional healthcare setting. To evaluate the clinical impact of standardised screening and management for iron deficiency in pregnancy within a regional Australian centre. Single centre, retrospective cohort observational study that audited medical records pre and post implementation of standardised screening and management for antenatal iron deficiency. We compared rates of anaemia at birth, rates of peripartum blood transfusions and rates of peripartum iron infusions. There were 2773 participants with 1372 participants in the pre-implementation group and 1401 in the post-implementation group. Participant demographics were similar. Anaemia at admission for birth decreased from 35% to 30% (RR 0.87, 95% CI (0.75, 1.00), p 0.043) Fewer blood transfusions were required (16 (1.2%) pre-implementation, 6 (0.4%) post-implementation, RR 0.40, 95% CI(0.16, 0.99), p 0.048). Antenatal iron infusions increased from 12% to 18% of participants post implementation (RR 1.47, 95% CI(1.22, 1.76), p 〈0.001).We audited compliance with the guidelines and found improvements post implementation. This is the first study to show clinically useful and statistically significant reduction in rates of anaemia and blood transfusions, post implementation of routine ferritin screening and management within a regional Australian population. The results of this study suggest there is benefit to implementation of standardised ferritin screening and management packages in Australian antenatal care. It also encourages RANZCOG to review current recommendations on screening for iron deficiency anaemia during pregnancy.

Heart Failure Discharge Checklist for Improving Quality of Care

Does evaluating the quality of heart failure (HF) care prior to discharge improve adherence to guideline-recommended care and equitable patient outcomes? A checklist tool was developed and implemented to measure and improve adherence against the 2022 European Society of Cardiology (ESC) Quality Indicators (QIs) for the care and outcomes of adults with heart failure. A retrospective audit was undertaken to evaluate performance against a checklist tool for 50 outpatients at discharge from a single-centre tertiary New Zealand hospital with a nurse practitioner/nurse specialist-led adult heart failure service. Performance measures were achieved for diagnosis of HF type by echocardiogram (ECHO), health practitioner review, and prescription of beta blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors. Rate of mineralocorticoid receptor antagonist prescriptions, screening for iron deficiency, cardiovascular risk assessment, documentation of QRS duration, and consideration of device therapy improved. Adoption of sodium/glucose cotransporter-2 inhibitors was limited by funding in the New Zealand context. Service constraints for repeat ECHO, HF rehabilitation programs, and use of a validated assessment tool to measure quality of life are targets for improvement. Adopting a discharge checklist improved interprofessional consistency in achieving optimal and individualised guideline-recommended care for patients, whilst improving service efficiency.

Single-Center Analysis of Essential Laboratory Testing in Patients with Newly Diagnosed Celiac Disease

To analyze laboratory testing results from pediatric patients newly diagnosed with celiac disease to determine the usefulness of each test derived from recommended guidelines. Serological testing at the time of diagnosis from patients enrolled in our celiac disease registry from January 2018 through December 2021 was reviewed. The incidence of abnormal laboratory results, routinely obtained as per the recommendations of Snyder etal and our institution's Celiac Care Index, was assessed. Rates of abnormal laboratory values and estimated costs associated with these screening measures were analyzed. Our data demonstrated abnormalities in all serological testing obtained at celiac diagnosis. Hemoglobin, alanine aminotransferase, ferritin, iron, and vitamin D screening were found to be abnormal with notable frequency. Only 7% of patients had an abnormal thyroid-stimulating hormone and <0.1% had an abnormal free T4. Nonresponse to hepatitis B vaccination was prominent, with 69% of patients considered nonimmune. Screening protocols as currently outlined in our Celiac Care Index resulted in an estimated cost of approximately $320000 during our study. Review of screening laboratory results at our center reveals that abnormal values for several recommended measures are uncommon. Thyroid screening was infrequently abnormal and the usefulness of screening for hepatitis B at diagnosis is uncertain. Similarly, our data suggest that iron deficiency screening may be condensed effectively into hemoglobin and ferritin testing, eliminating the need for initial iron studies. Decreasing baseline screening measures could safely decrease the burden of testing on patients and overall healthcare expenditures.

Iron deficiency in heart failure: screening, prevalence, incidence and outcome data from the Swedish Heart Failure Registry and the Stockholm CREAtinine Measurements collaborative project.

Iron deficiency (ID) is common in heart failure (HF) and linked with poor prognosis regardless of anaemia. We assessed temporal trends in ID testing, ID prevalence, ID incidence, iron need, and outcomes associated with ID in HF across the ejection fraction (EF) spectrum. From the Swedish HF registry, we enrolled 15 197 patients from Region Stockholm with available EF and collected laboratory tests from routine practice. Iron screening improved since 2016 but remained <25% as of 2018. In 1486 patients with iron biomarkers at baseline, the prevalence of ID was 55% (HF with reduced EF 54%; mildly reduced EF 51%; preserved EF 61%). Iron need was ≥1500 mg in 72% of patients. ID was independently associated with higher risk for HF rehospitalizations (incidence rate ratio [IRR] 1.62, 95% confidence interval [CI] 1.13-2.31) and with cardiovascular (CV) death or repeated HF hospitalizations (IRR 1.63, 95% CI 1.15-2.30) regardless of EF (p-interaction 0.21 and 0.26, respectively), but not with all-cause death, CV death, or first HF hospitalization. Among 96 patients without ID at baseline and with follow-up iron biomarkers, 21% developed ID within 6 months. Iron deficiency screening improved over time but is still limitedly implemented, despite being highly prevalent and incident, and independently associated with CV death or HF rehospitalizations regardless of EF. Most patients with ID had an iron need necessitating either repeated administrations of intravenous iron or a preparation permitting >1000 mg doses. These data highlight the need for improved screening for ID in HF.

Results from a type two hybrid-effectiveness study to implement a preoperative anemia and iron deficiency screening, evaluation, and management pathway.

Implementation of pathways to screen surgical patients for preoperative anemia and iron deficiency remains limited. This study sought to measure the impact of a theoretically informed, bespoke change package on improving the uptake of a Preoperative Anemia and Iron Deficiency Screening, Evaluation, and Management Pathway. Pre-post interventional study using a type two hybrid-effectiveness design evaluated implementation. Four hundred (400) patient medical record reviews provided the dataset (200 pre- and 200-post implementation). The primary outcome measure was compliance with the pathway. Secondary outcome measures (clinical outcomes) were anemia on day of surgery, exposure to a red blood cell (RBC) transfusion, and hospital length of stay. Validated surveys facilitated data collection of implementation measures. Propensity score-adjusted analyses determined the effect of the intervention on clinical outcomes, and a cost analysis determined the economic impact. For the primary outcome, compliance improved significantly post-implementation (Odds Ratio 10.6 [95% CI 4.4-25.5] p< .000). In secondary outcomes, adjusted analyses point estimates showed clinical outcomes were slightly improved for anemia on day of surgery (Odds Ratio 0.792 [95% CI 0.5-1.3] p= .32), RBC transfusion (Odds Ratio 0.86 [95% CI 0.41-1.78] p= .69) and hospital length of stay (Hazard Ratio 0.96 [95% CI 0.77-1.18] p= .67), although these were not statistically significant. Cost savings of $13,340 per patient were realized. Implementation outcomes were favorable for acceptability, appropriateness, and feasibility. The change package significantly improved compliance. The absence of a statistically significant change in clinical outcomes may be because the study was powered to detect an improvement in compliance only. Further prospective studies with larger samples are needed. Cost savings of $13,340 per patient were achieved and the change package was viewed favorably.

Review of blood donor deferral with emphasis on donor and patient safety.

Blood donor deferral is a part and parcel of the commitment of the blood transfusion services to assure the safety and health of the blood donor as well as the recipient. Periodic review of blood donor deferral is to incorporate or revoke deferral reasons based on the evidence generated in the process of review. Therefore, emphasis must be laid on preparing strategies to only judiciously defer blood donors, recruit and retain first time blood donors, which needs critical appraisal of the existing deferral policies, so that the evidence based changes can be done. A retrospective analysis of deferral in blood donors who presented at the blood donation centre of an institute of national importance over a span of nine years (2011-2019). Donors were screened as per the Drugs and Cosmetics Act 1940 and Rules 1945 given by the Ministry of Health and Family Welfare, Govt of India. There were 1,37,935 donors attempts, out of which 20,167 (14.6%) donors were deferred from donating blood. Most of the deferred donors were male (88.5%), first time (86.1%) and temporarily deferred (87.6%). Almost comparable number of donors (49.1 % & 48.5%) were deferred for donor safety and patient safety reasons respectively. Overall the three most common reasons for deferral were low hemoglobin (21.6%), hypertension (11.4%) and history of jaundice (9%). In donor safety reasons, low hemoglobin (43.4%), hypertension (22.9%) and low blood pressure (4.5%), and in patient safety, a history of jaundice (18.6%), common cold (15.8%), and high-risk behavior (8.8%) emerged as the three most common reasons for deferral respectively. Blood donor deferral is an essential quality indicator of the blood donor selection process. Initiatives like fortification of dietary ingredients with iron, optimizing protein in diet served in schools under mid-day meal program, screening for iron deficiency, hypertension and education about high-risk behavior in schools and colleges may have long term effects of promotion of better health.

Iron deficiency in patients scheduled for pancreatic resection: implications for prehabilitation practice in pancreatic surgery

Background: Preoperative anemia is a common finding in cancer patients and it is associated with postoperative allogeneic blood transfusions and increased morbidity and mortality. Iron deficiency (ID) is a frequent cause of anemia in cancer patients and constitutes a modifiable risk factor. Preoperative screening for ID and iron suppletion as part of a prehabilitation program can potentially have great impact on postoperative outcomes in pancreatic surgery.

Preoperative Identification and Management of Anemia in the Colorectal Surgery Patient.

Preoperative anemia is a common finding in patients undergoing colorectal surgery, particularly those with cancer. While often multifactorial, iron deficiency anemia remains the most common cause of anemia in this patient population. Although seemingly innocuous, preoperative anemia is associated with an increased risk of perioperative complications and need for allogenic blood transfusions, both of which may worsen cancer-specific survival. Preoperative correction of anemia and iron deficiency is thus necessary to diminish these risks. Current literature supports preoperative screening for anemia and iron deficiency in patients slated to undergo colorectal surgery for malignancy or for benign conditions with associated patient- or procedure-related risk factors. Accepted treatment regimens include iron supplementation-either oral or intravenous-as well as erythropoietin therapy. Autologous blood transfusion should not be utilized as a treatment for preoperative anemia when there is time to implement other corrective strategies. Additional study is still needed to better standardize preoperative screening and optimize treatment regimens.

Analysis of reasons for blood donor deferral in student population of Vojvodina

Introduction. The supply of blood from healthy blood donors (BD) is essential for safe blood transfusions. As students play an important role in providing adequate blood supplies, this study analyzes the frequency and reasons for blood donor deferral among the student population of Vojvodina, with the intention of reducing the rate of deferral and improving re-entry. Material and Methods. A retrospective study examined blood donor deferral records of the University of Novi Sad students who donated blood at the Blood Transfusion Institute of Vojvodina, from January 1 to December 31, 2022. The deferrals have been categorized based on pre-donation deferral causes, the blood donor deferral period, in relevance to the safety of both the blood donor and the recipient. Results. Of 867 students in total, 121 (13.9%) were deferred from donating blood. 72/121 (59.5%) of them were female, 49/121 (11.3%) were male, and 99/121 (81.8%) were regular blood donors. Temporary deferrals of less than 3 months were recorded for 98/121 (80.99%) students, while deferrals for 6 months were applicable to 19/121 (15.7%), with 4/121 (3.3%) experiencing permanent deferrals. The number of blood donors deferred due to safety reasons of the very donors was 85/121 (70.2%). The most common reasons were low hemoglobin level 17/121 (14.1%), medication deferral (pain-killers, antihista?mines, antibiotics) 17/121 (14.1%) and adverse reactions prior to blood donation 15/121 (12.3%). Conclusion. Educating blood donors about high-risk behaviors, medication usage, screening for iron deficiency and hypertension could be the most important tool to reduce the rate of deferral and improve blood donor re-entry.

Iron Deficiency and Blood Donation: Links, Risks and Management.

The purpose of this review is to raise awareness about the frequently underappreciated association of blood donation with iron deficiency, and to describe methods for its prevention and management. Blood donors cannot expect any health benefits from the donation but have justified expectations of no harm. Iron deficiency without anemia (IDWA) and iron deficiency anemia (IDA) are common consequences of regular blood donation, and this activity is the most important factor affecting iron status in regular blood donors. Awareness of blood donation as a primary cause of sideropenia is surprisingly low among physicians. Blood donation screening identifies potential donors with IDA but is frequently inadequate to detect IDWA. For the assessment of body iron stores, plasma or serum ferritin, transferrin saturation (TSAT) and soluble transferrin receptors (sTfR) concentrations are the most widely used biochemical markers, although the percentage of hypochromic mature erythrocytes and the hemoglobin content of reticulocytes are also useful. IDWA can be prevented by limiting the total volume of blood collected, by iron deficiency screening and deferral of sideropenic donors, by prolonging the interdonation intervals, and by iron supplementation between donations. IDWA tends to be more prevalent in younger people, females, and high-intensity donors. A potentially effective strategy to address sideropenia in blood donors is serum ferritin testing, but this may lead to a higher rate of deferral. Most regular blood donors cannot replenish their iron deficit by an iron-rich diet alone and will benefit from low-dose oral iron administration with various commercially available products post-donation, a well-tolerated strategy. However, valid concerns exist regarding the possibility of worsening the iron overload in donors with undiagnosed hemochromatosis or masking the symptoms of a clinically important gastrointestinal hemorrhage or other underlying medical condition. Finally, educational efforts should be intensified to improve the awareness of blood donation as a primary cause of iron deficiency among physicians of all specialties.

Diagnosis and Treatment of Iron Deficiency and Anemia in Youth With Inflammatory Bowel Disease.

Iron deficiency (ID) with and without anemia is prevalent in children and adults diagnosed with inflammatory bowel disease (IBD), but often goes unrecognized. We hypothesized, quality improvement (QI) methodology could increase the screening for and treatment of ID in children newly diagnosed with IBD. We developed and implemented an easy-to-follow algorithm to facilitate screening for and treatment of ID for patients diagnosed with IBD. Through a series of Plan-Do-Study-Act cycles, the approach was modified to increase screening and treatment of ID. Data between January 2019 and July 2021 were assessed using statistical process control. Among patients newly diagnosed with IBD, 298 patients were included (67% Crohn disease, 29% ulcerative colitis, 4% indeterminate colitis, and 56% males). Rates of ID screening increased significantly from a baseline of 20% to >90%. Of the 232 patients screened for ID during the improvement period, 205 (88%) met criteria for either iron deficiency anemia (IDA) or ID at diagnosis, specifically, 151 (65%) met criteria for IDA and 54 (23%) met criteria for ID. Use of QI methodology to standardize screening assessments for ID among children newly diagnosed with IBD improved screening rates from a baseline of 20% to >90%, with 88% of patients found to have IDA or ID.