title: A fast-track anaemia clinic in the Emergency Department: feasibility and efficacy of intravenous iron administration for treating sub-acute iron deficiency anaemia.
abstract: BACKGROUND
  Clinically significant anaemia, requiring red blood cell transfusions, is frequently observed in Emergency Departments (ED). To optimise blood product use, we developed a clinical protocol for the management of iron-deficiency anaemia in a fast-track anaemia clinic within the ED.
  
  
  METHODS
  From November 2010 to January 2014, patients presenting with sub-acute, moderate-to-severe anaemia (haemoglobin [Hb] <11 g/dL) and confirmed or suspected iron deficiency were referred to the fast-track anaemia clinic. Those with absolute or functional iron deficiency were given intravenous (IV) ferric carboxymaltose 500-1,000 mg/week and were reassessed 4 weeks after receiving the total iron dose. The primary study outcome was the haematological response (Hb≥12 g/dL and/or Hb increment ≥2 g/dL). Changes in blood and iron parameters, transfusion rates and IV iron-related adverse drug effects were secondary outcomes.
  
  
  RESULTS
  Two hundred and two anaemic patients with iron deficiency (150 women/52 men; mean age, 64 years) were managed in the fast-track anaemia clinic, and received a median IV iron dose of 1,500 mg (1,000-2,000 mg). Gastro-intestinal (44%) or gynaecological (26%) bleeding was the most frequent cause of the anaemia. At follow-up (183 patients), the mean Hb increment was 3.9±2.2 g/dL; 84% of patients were classified as responders and blood and iron parameters normalised in 90%. During follow-up, 35 (17%) patients needed transfusions (2 [range: 1-3] units per patient) because they had low Hb levels, symptoms of anaemia and/or were at risk. Eight mild and one moderate, self-limited adverse drug effects were witnessed.
  
  
  CONCLUSIONS
  Our data support the feasibility of a clinical protocol for management of sub-acute anaemia with IV iron in the ED. IV iron was efficacious, safe and well tolerated. Early management of anaemia will improve the use of blood products in the ED.
authors.affiliation: Emergency Department, University Hospital La Paz, Madrid, Spain.|Intensive Care Unit, University Hospital La Paz, Madrid, Spain.|Emergency Medicine Research Group, Research Institute University Hospital La Paz (IdiPAZ), Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Quintana-Díaz
authors.affiliation: Emergency Department, University Hospital La Paz, Madrid, Spain.|Emergency Medicine Research Group, Research Institute University Hospital La Paz (IdiPAZ), Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Fabra-Cadenas
authors.affiliation: Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Gómez-Ramírez
authors.affiliation: Emergency Department, University Hospital La Paz, Madrid, Spain.|Emergency Medicine Research Group, Research Institute University Hospital La Paz (IdiPAZ), Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Martínez-Virto
authors.affiliation: Emergency Medicine Research Group, Research Institute University Hospital La Paz (IdiPAZ), Madrid, Spain.|Haematology and Haemotherapy Service, General Hospital San Jorge, Huesca, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: García-Erce
authors.affiliation: Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007501:Iron / Q000008:administration & dosage* / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007501:Iron