Iron Supplementation is Underutilized after Hospitalization for Gastrointestinal Bleeding

Abstract

Introduction: Iron deficiency anemia (IDA) is common in the hospital setting and is frequently caused by gastrointestinal bleeding (GIB). While treatment is aimed at the underlying cause of IDA, it is also targeted at replenishing iron stores to reduce anemia progression and decrease the risk of end organ damage. Objective: The primary aim of this study was to assess whether patients hospitalized with IDA secondary to GIB received iron supplementation upon discharge. Methods: Retrospective analysis evaluating 992 patients admitted to our tertiary care hospital from 1/1/17-12/1/17 who underwent endoscopy for GIB. IDA was defined as ferritin ≤ 30, iron saturation ≤ 10% or a ≥ 2gram drop from the patient's baseline hemoglobin. A secondary endpoint assessed readmission rates within a 180-day follow up period after discharge and associated morbidity and mortality. Results: A total of 228 patients met inclusion criteria for analysis. There were 115 males (50.4%) with an overall mean age of 62.6± 2.1y. Overall, 106 (46.5%) patients eligible by our criteria to receive iron therapy were discharged on this therapy. In regression analysis, receiving iron (OR = 13.6; 95% CI, 7.0-26.6) or a blood transfusion (2.72; 1.1-6.9) during hospitalization were independently associated with discharge on iron. Discharge on iron was not associated with readmission but there was a non-significant trend toward anemia improvement for those supplemented with iron. Conclusions: At our institution, physicians failed to provide iron supplementation on discharge to over 50% of eligible patients. Patients diagnosed with IDA secondary to GIB are more likely to be discharged with iron supplementation if it was started during hospitalization or they received a blood transfusion. We believe the medication reconciliation performed automatically by the electronic medical record (EMR) at the time of discharge had a significant impact on this finding.