Red blood cell transfusion after a global strategy for early detection and treatment of iron deficiency anemia: three‐year results of a prospective observational study

Nieves, M; Cobos, Ana Maria Matas; Gonzalez, Francisco Sarria; Lomeña, Maria Jose Dominguez; Hernandez, Ana Maria Palomo; Gines, Encarnación Gil; Juan, Salvador Serna; Ampuero, Javier; Fernandez, Antonio Marin; Villa, Antonia Vazquez de la

doi:10.1111/trf.14582

Cited by 2 publications

(2 citation statements)

References 32 publications

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“…Previous endeavors to reduce PRBC transfusion rates have been successfully executed for a variety of patient populations using various methods 30–33 . However, few studies focus specifically on IDA 14,23 . One group implemented a risk‐based algorithm using QI methodology for management of adults presenting to the ED with IDA in a large tertiary care center in Toronto, Canada and achieved a 91% rate of appropriate PRBC transfusions compared with a historical average of 53% 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Comprehensive guidelines on management of IDA, particularly for young children, are lacking, leading to variability in care including excessive testing or inappropriate treatment selection 11,12 . While expert guidelines 13 and prospective studies 14 to reduce packed red blood cell (PRBC) transfusions in IDA exist, they are limited to adults or the primary care setting. The Choosing Wisely® campaign highlighted several management principles with growing evidence for application to pediatric IDA.…”

Section: Introductionmentioning

confidence: 99%

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Management of nutritional iron deficiency anemia for young children in the emergency department

McEvoy

Stuckert

Castellanos

et al. 2022

Pediatric Blood & Cancer

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Background Guidelines for young children with nutritional iron deficiency anemia (IDA) presenting to the emergency department (ED) are lacking, leading to variability in care. We aimed to standardize management of these patients through the development and implementation of an evidence‐based algorithm using quality improvement methodology. Procedure Baseline data of the target population (n = 42; 60% male; median age 22.5 months, median hemoglobin 5.3 g/dl) identified variability across four key measures of clinical management: laboratory evaluation, therapy choice, therapy administration, and patient disposition. Literature review and consensus from pediatric hematology providers informed a draft algorithm that was refined in an iterative multidisciplinary process. From September 2020 to June 2021, we aimed to increase IDA management per the algorithm by ≥20% relative to baseline for the four key outcome measures using sequential Plan‐Do‐Study‐Act (PDSA) cycles. Process measures focusing on provider communication/documentation and balancing measures involving efficiency and therapy‐related adverse events were assessed concurrently. Results Thirty‐five patients were evaluated among four PDSA cycles and shared similar characteristics as the baseline population. Improvements of ≥20% above baseline adherence levels or 100% adherence were achieved for all outcome measure across four PDSA cycles. Adherence to recommended laboratory evaluation improved from 43 (baseline) to 71%, therapy choice from 78 to 100%, therapy administration from 50 to 83%, and disposition from 85 to 100%. ED length of stay remained stable. Conclusions Implementation of a standardized algorithm for young children with nutritional IDA in the ED increased adherence to evidence‐based patient care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of nutritional iron deficiency anemia for young children in the emergency department

McEvoy

Stuckert

Castellanos

et al. 2022

Pediatric Blood & Cancer

View full text Add to dashboard Cite

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The efficacy of intravenous iron for treatment of anemia before cardiac surgery: An updated systematic review and meta-analysis with trial sequential analysis

Tang

et al. 2023

J Cardiothorac Surg

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Background Preoperative anemia is common in patients undergoing cardiac surgery with various etiologies, among which iron deficiency is the leading cause. However, the benefit of intravenous (IV) iron for the treatment of anemia before cardiac surgery is uncertain. This updated meta-analysis aimed to evaluate the efficacy of IV iron in adult cardiac surgery patients with preoperative anemia. Methods This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched Embase, PubMed and the Cochrane Central Register of Controlled Trials to identify eligible randomized controlled trials (RCTs) and observational studies. Quality was assessed using the Cochrane Collaboration risk of bias tool and Newcastle–Ottawa scale, and the strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. Trial sequential analysis was performed on the primary outcome (transfusion rate) to confirm whether firm evidence was reached. Results Six RCTs (936 patients) and 5 observational studies (1350 patients) were included in this meta-analysis. The IV iron group and the control group were comparable in terms of transfusion rate [55.1% vs 60.9%, risk ratio (RR) = 0.91, 95% confidence interval (CI) 0.81–1.03, P = 0.13, low quality]. There were no significant differences in units transfused per patient, ICU stay and hospital length of stay between the two groups. And pooled data showed a benefit of IV iron compared to the control group on mortality (2.76% vs 3.75%, RR = 0.58, 95% CI 0.36–0.95, P = 0.03, moderate quality) and no mortality reduction existed when including only RCTs. Conclusions This meta-analysis suggested that IV iron treatment for patients with anemia before cardiac surgery did not reduce the transfusion requirement (low quality), but it was associated with decreased mortality (moderate quality). More large-scale, high-quality randomized clinical trials are warranted to confirm or refute our findings. PROSPERO registry reference: CRD42022331875.

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Red blood cell transfusion after a global strategy for early detection and treatment of iron deficiency anemia: three‐year results of a prospective observational study

Abstract: Management of IDA is a target to avoid RBC transfusion, and awareness of this health problem should be among the first pillars for any patient blood management program.

Cited by 2 publications

References 32 publications

Management of nutritional iron deficiency anemia for young children in the emergency department

Management of nutritional iron deficiency anemia for young children in the emergency department

The efficacy of intravenous iron for treatment of anemia before cardiac surgery: An updated systematic review and meta-analysis with trial sequential analysis

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