PWE-031 Re-evaluating investigation and management of anaemia in inflammatory bowel disease

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Abstract

Introduction

Anaemia is the most prevalent extra-intestinal manifestation of inflammatory bowel disease (IBD), affecting up to 66% of inpatients admitted with a flare of IBD. European guidelines published in 2015 define clear management priorities for such patients.1 Here we present a re-audit of the practice of a large teaching hospital following introduction of a local guideline based on the European consensus.

Methods

We retrospectively identified and analysed the casenotes of all patients admitted to North Bristol NHS Trust between 2015 and 2017 presenting with a flare or new diagnosis of IBD. Data collected included patient demographics, admission haemoglobin (Hb) and ferritin levels, and prescription of oral or intravenous iron during admission. These data were compared to a historical dataset from 2014 prior to the local guideline introduction.

Result

25 patients (mean age 53.2 years (SD 20.8), 11 (44%) female) were identified that matched the selection criteria post- intervention, compared to 54 patients (mean age 43.7 years (SD 19.6), 30 (55.6%) female) pre- intervention. The median length of stay was 5 days (interquartile range 3 to 11). 14 had Crohn’s disease and 11 had ulcerative colitis. There was no significant difference in age, diagnosis nor gender pre- and post- intervention. In anaemic patients with ferritin values under 100 μg/L, more patients had an iron infusion prescribed (33.3% vs 16.7%) and iron deficiency anaemia was more commonly mentioned on discharge summaries (66.7% vs 33.3%) compared to the pre-guideline population, but this did not reach significance (p=0.519 and 0.292 respectively). No improvement was seen in whether ferritin was checked during admission (p=0.111). Hb negatively correlated with length of stay (p=0.006), corroborating findings from the pre-intervention cohort.

Conclusion

Since adopting European guidelines on the investigation and management of anaemia in IBD practice at our Trust has improved, but not significantly so – clearly there is more work to do. Our findings will be reviewed at local clinical governance meetings. This will be accompanied by further clinician education and a review of our electronic ‘order set’ so necessary investigations can be requested on IBD patients at the front door.

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