Contributions
Abstract: PB2071
Type: Publication Only
Background
Iron deficiency is common in Inflammatory Bowel Diseases (IBD), unfortunately oral iron supplements are often poorly tolerated and parenteral iron is used instead. National and international guidelines establish the best practice regarding diagnosis of iron deficiency, indication for parenteral iron therapy and follow up recommendations.
Regular audits are an effective tool to ensure the guidelines are followed and to improve local practice.
Aims
The aim of the study was to compare the parenteral iron therapy practice in Ealing hospital with the national and international standards.
We looked at the blood test used to diagnose iron deficiency: haemoglobin, ferritin and transferrin saturation if ferritin normal or high.
We also evaluated the appropriateness of parenteral iron therapy according to the guidelines; first line parenteral therapy is indicated for haemoglobin levels lower than100 g/l, IV iron is used as second line in patients not responsive or intolerant to oral iron.
Follow up should be performed at least four weeks after the infusion and within three monthsand should include haemoglobin and ferritin; in case of iron deficiency the patient should be prescribed further iron therapy.
Methods
Parenteral iron prescriptions for patients with IBD were identified. The hospital informatics system was used to retrieve clinical data and blood test results. Twelve months data were taken in account.
Results
We identified 19 prescriptions for 15 patients. One patient, who had 3 prescriptions, had blood test done with an unusual pattern, she was on iron infusion maintenance every four months and she had follow up blood tests done two weeks after the infusion, too early for follow up and too old for diagnosis of iron deficiency at the time of the iron infusion. In the remaining 16 cases iron deficiency was confirmed in the months before by FBC and ferritin; transferrin saturation was performed in all 4 cases with normal ferritin. Of the 19 prescription 15 were definitely appropriate; in 4 cases appropriateness was not evaluable (3 due to lack of recent blood tests, in 1 case haemoglobin was >100g/L, too high to justify IV iron as first line therapy, and there was no clinical information on previous oral iron therapy). Follow up was done in 18 cases but timing was variable. Only in 8 cases follow up was arranged within 3 months as suggested by the guidelines, in 5 cases the follow up was arranged earlier and in the remaining 5 later. In 4 cases the follow up was not acted upon, the patients were still iron deficient but no further iron therapy was prescribed.
Conclusion
The results were discussed with the IBD team to create an action plan to improve patients’ care. Diagnosis was good and appropriateness wad acceptable, the only patient who had an abnormal pattern of blood tests will be contacted to modify how therapy is given and monitored. Follow up practice was the main issue, this was due to lack of dedicated specialist nurse who could organise day unit appointment and follow up. The clinician seeing the patient and prescribing parenteral iron will take responsibility of ensuring that iron deficiency is confirmed with recent blood tests and appropriate follow up, either with an appointment in the IBD clinic or through the General Practitioner, is organised. Once applied these changes the audit should be repeated in one year to ensure the changes improved the compliance with international guidelines.
Session topic: 30. Iron metabolism, deficiency and overload
Keyword(s): Iron deficiency anemia, Therapy
Abstract: PB2071
Type: Publication Only
Background
Iron deficiency is common in Inflammatory Bowel Diseases (IBD), unfortunately oral iron supplements are often poorly tolerated and parenteral iron is used instead. National and international guidelines establish the best practice regarding diagnosis of iron deficiency, indication for parenteral iron therapy and follow up recommendations.
Regular audits are an effective tool to ensure the guidelines are followed and to improve local practice.
Aims
The aim of the study was to compare the parenteral iron therapy practice in Ealing hospital with the national and international standards.
We looked at the blood test used to diagnose iron deficiency: haemoglobin, ferritin and transferrin saturation if ferritin normal or high.
We also evaluated the appropriateness of parenteral iron therapy according to the guidelines; first line parenteral therapy is indicated for haemoglobin levels lower than100 g/l, IV iron is used as second line in patients not responsive or intolerant to oral iron.
Follow up should be performed at least four weeks after the infusion and within three monthsand should include haemoglobin and ferritin; in case of iron deficiency the patient should be prescribed further iron therapy.
Methods
Parenteral iron prescriptions for patients with IBD were identified. The hospital informatics system was used to retrieve clinical data and blood test results. Twelve months data were taken in account.
Results
We identified 19 prescriptions for 15 patients. One patient, who had 3 prescriptions, had blood test done with an unusual pattern, she was on iron infusion maintenance every four months and she had follow up blood tests done two weeks after the infusion, too early for follow up and too old for diagnosis of iron deficiency at the time of the iron infusion. In the remaining 16 cases iron deficiency was confirmed in the months before by FBC and ferritin; transferrin saturation was performed in all 4 cases with normal ferritin. Of the 19 prescription 15 were definitely appropriate; in 4 cases appropriateness was not evaluable (3 due to lack of recent blood tests, in 1 case haemoglobin was >100g/L, too high to justify IV iron as first line therapy, and there was no clinical information on previous oral iron therapy). Follow up was done in 18 cases but timing was variable. Only in 8 cases follow up was arranged within 3 months as suggested by the guidelines, in 5 cases the follow up was arranged earlier and in the remaining 5 later. In 4 cases the follow up was not acted upon, the patients were still iron deficient but no further iron therapy was prescribed.
Conclusion
The results were discussed with the IBD team to create an action plan to improve patients’ care. Diagnosis was good and appropriateness wad acceptable, the only patient who had an abnormal pattern of blood tests will be contacted to modify how therapy is given and monitored. Follow up practice was the main issue, this was due to lack of dedicated specialist nurse who could organise day unit appointment and follow up. The clinician seeing the patient and prescribing parenteral iron will take responsibility of ensuring that iron deficiency is confirmed with recent blood tests and appropriate follow up, either with an appointment in the IBD clinic or through the General Practitioner, is organised. Once applied these changes the audit should be repeated in one year to ensure the changes improved the compliance with international guidelines.
Session topic: 30. Iron metabolism, deficiency and overload
Keyword(s): Iron deficiency anemia, Therapy