Iron-deficiency anemia: a medically treatable chronic anemia as a model for transfusion overuse.
OBJECTIVE
Transfusion practice in patients with iron deficiency was reviewed.


METHODS
During the study period, records of 265 consecutive patients with an unsaturated iron-binding capacity of greater than 53.7 mumol/L were evaluated for possible iron-deficiency anemia.


RESULTS
Two hundred sixty-three patients met the study criteria for iron deficiency. Of these patients, 50 received 1 or more units of red blood cells (RBCs). The transfusion therapy of 12 patients could not be justified; physicians used laboratory results rather than the clinical status of the patients to initiate transfusion therapy. As a result, units of RBCs were transfused to raise the hematocrit to an arbitrarily chosen level. Furthermore, iron therapy was not prescribed for 97 of the 263 iron-deficient patients, including 11 of the patients for whom transfusion was justifiable and 2 patients for whom transfusion could not be justified. Based on records reviewed, no work-up was initiated to identify the cause of iron deficiency in 13 patients, including 4 patients who received transfusions.


CONCLUSIONS
These findings suggest that the evaluation and treatment of iron deficiency, including transfusion therapy for that condition, may be problematic. In view of the risks of blood transfusion therapy, improvement in transfusion practices for iron deficiency should be emphasized.
Saxena
S
S
Department of Pathology, Los Angeles County and University of Southern California Medical Center 90033.
Rabinowitz
A P
AP
Johnson
C
C
Shulman
I A
IA
D000747:Anemia, Hypochromic / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002908:Chronic Disease; D004909:Erythrocyte Indices; D005260:Female; D005293:Ferritins / Q000097:blood; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000150:complications; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007501:Iron / Q000097:blood; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011674:Pulse; D014168:Transferrin / Q000032:analysis; D014592:Uterine Hemorrhage / Q000150:complications
D006454:Hemoglobins; D014168:Transferrin; D005293:Ferritins; D007501:Iron