Iron deficiency anemia in the emergency department: over-utilization of red blood cell transfusion and infrequent use of iron supplementation.
OBJECTIVE
Three are no clinical practice guidelines that specifically address the management of patients with iron deficiency anemia (IDA) in the emergency department (ED). The goal of this study was to describe the characteristics of IDA patients who present to the ED, documentation of IDA by emergency physicians, utilization of iron supplementation, and the appropriateness of red blood cell (RBC) transfusions ordered in the ED.


METHODS
A retrospective medical chart review was performed of IDA patients who visited the ED of a large tertiary center over a three-month period. Appropriateness of RBC transfusion was determined using a novel algorithm developed by our institution.


RESULTS
Over the study period, there was a 0.3% (49/14,394) prevalence of IDA in the ED. In thirty (30/49; 61%) patients, IDA was documented by an emergency physician. RBC transfusions were administered to 19 patients; 10 transfusions (53%) were appropriate, 3 (16%) were appropriate for indication, but more than the required number of units were ordered, and 6 (32%) were inappropriate. Of the patients discharged, one (1/25; 4%) patient received intravenous iron in the ED and 6 of the 11 patients (55%) that were not already taking oral iron received a prescription at discharge from the ED.


CONCLUSIONS
This assessment demonstrated that management of IDA patients presenting to the ED may represent an important knowledge-to-practice gap. It revealed that RBC transfusion may be over-utilized and could be replaced by safer, lower-cost alternatives such as intravenous and oral iron. Guidelines for management of IDA in the ED may be necessary to achieve consistent IDA management and avoid inappropriate use of RBC transfusion.
*Faculty of Arts and Science,University of Toronto,Toronto,ON.
Jordan
J
Spradbrow
†Department of Laboratory Medicine and Pathobiology,University of Toronto,Toronto,ON.
Yulia
Y
Lin
‡Division of Emergency Medicine,University of Toronto,Toronto,ON.
Dominick
D
Shelton
†Department of Laboratory Medicine and Pathobiology,University of Toronto,Toronto,ON.
Jeannie
J
Callum
D000328:Adult; D000368:Aged; D000465:Algorithms; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002170:Canada; D015331:Cohort Studies; D016208:Databases, Factual; D019587:Dietary Supplements; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers; D055815:Young Adult
D007501:Iron
emergency department; intravenous iron; iron deficiency anemia