Background Iron deficiency is highly prevalent worldwide and is an issue of health inequity. Despite its high prevalence, uncertainty on the clinical applicability and evidence‐base of iron‐related lab test cut‐offs remains. In particular, current ferritin decision limits for the diagnosis of iron deficiency may not be clinically appropriate nor scientifically grounded. Methods A modified Delphi study was conducted with various clinical experts who manage iron deficiency across Canada. Statements about ferritin decision limits were generated by a steering committee, then distributed to the expert panel to vote on agreement with the aim of achieving consensus and acquiring feedback on the presented statements. Consensus was reached after two rounds, which was defined as 70% of experts rating their agreement for a statement as 5 or higher on a Likert scale from 1 to 7. Results Twenty‐six clinical experts across 10 different specialties took part in the study. Consensus was achieved on 28 ferritin decision limit statements in various populations (including patients with multiple comorbid conditions, pediatric patients, and pregnant patients). For example, there was consensus that a ferritin <30 μg/L rules in iron deficiency in all adult patients (age ≥ 18 years) and warrants iron replacement therapy. Conclusion Consensus statements generated through this study corresponded with current evidence‐based literature and guidelines. These statements provide clarity to facilitate clinical decisions around the appropriate detection and management of iron deficiency.
Background: Post-partum hemorrhage (PPH) is a major cause of maternal mortality. The risk of death from PPH is approximately 1 in 1000 deliveries(Carroli et al., 2008). Tranexamic acid (TXA) is a recommended treatment for women with severe PPH as it significantly reduces blood loss, need for surgical intervention and maternal mortality from hemorrhage (Abdul-Kadir et al., 2014; Ducloy-Bouthors et al., 2011; Li et al., 2017). Despite evidence supporting the use of TXA in this setting, there remain concerns and reluctance with its use stemming from the known increased risk of venous thromboembolism (VTE) in women post-partum (Tepper et al., 2014; James, 2009). Much of the data on TXA use has come from studies conducted on women without a bleeding disorder. Women with inherited bleeding disorders are at a substantially greater risk of PPH with maternal mortality from PPH estimated to be 10 times higher than average(Abdul-Kadir et al., 2014; James & Jamison, 2007). The safety and efficacy of peri-partum use of TXA in this population warrants study given their increased baseline risk of PPH and lower risk of thromboembolism (James & Jamison, 2007; Martin & Key, 2016). Methods: A retrospective cohort study was conducted on all women with inherited bleeding disorders known to our Multidisciplinary Clinic for Women with Inherited Bleeding Disorders (MCWBD) who received TXA peri-partum between July 2014 and December 2019. The primary objective was to evaluate the frequency of VTE amongst patients with inherited bleeding disorders who received peri-partum TXA. The secondary objective was to evaluate the frequency of primary and secondary PPH among those who did and did not receive TXA. Research ethics board approval was obtained. Descriptive statistical analyses were used. Results: There were no VTE events in all MCWBD patients who received TXA peri-partum. A total of 40 patients with inherited bleeding disorders were managed from the beginning of pregnancy to labour and delivery under the care of the MCWBD between July 2014 and December 2019. The distribution of primary bleeding disorder diagnoses is 37.5% (15/40) for von Willebrand disease, 30% (12/40) had platelet function disorders, 22.5% (9/40) were symptomatic hemophilia carriers and 10% (4/40) had a rare factor deficiency (see Figure 1). Of these patients, 25% (10/40) had a personal previous history of PPH and 13% (5/40) had a family history of PPH. Among the 40 women, 75% (30/40) gave birth vaginally. TXA was provided to 95% (38/40) of patients at the onset of the second stage of labour, during the postpartum period (minimum of 10 days of oral TXA treatment), or both. Primary PPH occurred in 13% (5/38) of women who received prophylactic TXA and in 1 out 2 (50%) women without prophylactic TXA (see Table 1). There were no reports of secondary PPH. Conclusions: TXA appears to be a safe preventative treatment for PPH in patients with inherited bleeding disorders based on our retrospective study, with no additional risks of thromboembolism observed. Prospective evaluation of peripartum TXA use in this patient population is warranted to further assess its efficacy. Disclosures Martin: Borden Ladner Gervais LLP: Consultancy. Sholzberg:NovoNordisk: Honoraria, Other: Scientific Advisory Board; Novartis: Honoraria, Other: Scientific Advisory Board; Takeda: Honoraria, Other: Scientific Advisory Board, Research Funding; Amgen: Honoraria, Other: Scientific Advisory Board, Research Funding; Octapharma: Honoraria, Other: Scientific Advisory Board, Research Funding.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.