PTU-079 Ambulatory management of symptomatic anaemia

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Abstract

Introduction

Current NICE guidance recommends restrictive blood transfusions to a target haemoglobin of 70–90 g/L.1 In cases of symptomatic iron deficiency anaemia (IDA), parenteral iron is effective.2 New IDA warrants urgent investigation. The financial burden of IDA is high rendering the introduction of an ambulatory management pathway at our trust beneficial.

Methods

A single-centre retrospective analysis was undertaken of all patients with symptomatic anaemia, referred to ambulatory care between February and September 2017. Our aim was to assess pathway adherence and estimate cost savings.

Results

54 patients (26M; 28F) were referred to ambulatory care between 1/2/17 to 4/9/17 via the anaemia pathway. Mean age was 69 years (range 25 to 97). 44 (81%) were GP referrals whilst 10 (19%) were internal referrals. 72% (n=39) of patients were treated within 24 hours of referral; 17% (n=9) within 2–3 days; 11% (n=6) within 4–11 days.

Results

81% (n=44) of these patients were ambulatory; 19% (n=10) required an in-patient stay for co-existing medical concerns. Causes of known anaemia included: GAVE – 7 (13%); Chronic illness – 9 (17%); Malignancy – 14 (26%); Gynaecological – 4 (7%). Of 20 (37%) patients with new anaemia, 15 (75%) patients were seen within 2 weeks by the relevant team. 2 (10%) delays occurred. 3 (15%) patients did not have IDA.

Results

32 (59%) patients had IDA; 19 received intravenous iron alone (ferritin 3–57.7 ug/L, Hb 72–92 g/L); 13 received parenteral iron plus blood transfusion (ferritin 1.3–125.3 ug/L, Hb 56–80 g/L) and 22 had a transfusion alone (ferritin 12.8–3047.6 ug/L, Hb 53–82 g/L).

Conclusions

The introduction of the anaemia pathway, has reduced emergency admissions of patients with symptomatic anaemia. Cancer fast track referrals of IDA have been effective and appropriately triaged and the anaemia pathway has been adhered to. IDA has been treated with parenteral iron, enabling restrictive transfusion. Each emergency IDA admission is estimated to cost £1165 more than a day case (£1640 vs £475, respectively).3 Between February and September 2017, we estimate to have saved 44 such admissions, resulting in an estimated cost saving of £51 260.

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