A synchronized approach between emergency department and anemia clinic to intravenous iron treatment for very severe (Hb <7.0 g/dL) and extreme (<5.0 g/dL) iron-deficiency anemia: short-, medium- and long-term efficacy and safety analysis

Abstract

Background - Iron deficiency anaemia is common in patients admitted to Emergency department or referred to Anaemia clinic by general practitioners. The objective of this study was to assess and compare baseline characteristics and haemoglobin recovery of hemodynamically stable patients with very severe (Hb ≥5.0 to 7.0 g/dL) or extreme (Hb <5.0 g/dL) anaemia treated in the first instance at Emergency department or Anaemia clinic with intravenous iron only.
Material and methods - Data was collected over a 34-month period. Patients who received the first infusion in the Emergency department were then referred to the Anaemia clinic for subsequent therapy and follow-up.
Results - 47 patients met the inclusion criteria. 8 (17.0%) patients presented with extreme anaemia. 28 patients received the first intravenous iron infusion in the Emergency department (mean Hb 6.0 g/dL) and 19 in the Anaemia clinic (mean Hb 6.5 g/dL). 18 patients were over 65 years of age (38.3%). On receiving an average total IV iron dose of 1500mg, Hb increased by 2.5 g/dL and 5.9 g/dL on days 10 and 35 respectively following the first infusion. No side effects were recorded and none of the patients were transfused at the subsequent follow-up.
Discussion - Our study confirms that intravenous iron therapy is an effective, safe, and practical option even in cases of critical iron deficiency anaemia and, rather than blood transfusion, should be considered the first treatment choice in hemodynamically stable patients. Legnano General Hospital has adopted a synchronized approach between the Emergency department and Anaemia clinic for the treatment of severe iron deficiency anaemia.