Treatment with ferric carboxymaltose in stable patients with severe iron deficiency anemia in the emergency department

Irene Motta, Giulia Mantovan, Dario Consonni, Anna Maria Brambilla, Maria Materia, Marianna Porzio, Margherita Migone De Amicis, Nicola Montano, Maria Domenica Cappellini

Research output: Contribution to journalArticle

Abstract

The AABB Choosing Wisely Campaign recommends “don’t transfuse for iron deficiency without hemodynamic instability”. However, the management of iron deficiency anemia (IDA) in the emergency department (ED) is heterogeneous and patients are often over-transfused. Intravenous iron is effective in correcting anemia and new formulations, including ferric carboxymaltose (FCM), allow the administration of high doses with low immunogenicity. The aim of this retrospective study was to analyze the management of hemodynamically stable patients aged 18–55 years with severe IDA (hemoglobin < 8 g/dL), who presented to the ED from January 2014 to July 2018. Patients who received FCM (FCM1) and those who did not receive FCM (FCM0) were compared. Efficacy and safety of FCM at follow-up were evaluated. Seventy-one subjects fulfilled the inclusion criteria (FCM0 n = 48; FCM1 n = 23). The mean Hb at admission was 6.6 g/dL. 40% in the FCM0 and 13% in FCM1 were transfused (p = 0.02). 21% of FCM0 patients were admitted to the ward, while all FCM1 were discharged (p = 0.02). Within 2 weeks, the Hb increase was 2.8 ± 1 g/dL in the FCM1 group. Sixteen FCM1 patients were evaluated at 52 ± 28 days (median 42, range 27–122): the average Hb increase was 5.3 ± 1.4 g/dL. In summary, we showed that FCM administration in the ED in hemodynamically stable patients was associated with fewer transfusions and hospital admissions compared to the FCM0 group; moreover, it succeeded in safely, effectively and rapidly increasing Hb levels after discharge from the ED. Further studies are needed to develop recommendations for IDA in the ED and to identify transfusion thresholds for non-hospitalized patients.

Original languageEnglish
JournalInternal and Emergency Medicine
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Iron-Deficiency Anemias
Hospital Emergency Service
Therapeutics
Iron
ferric carboxymaltose
Anemia
Hemoglobins
Retrospective Studies
Hemodynamics
Safety

Keywords

  • Choosing wisely
  • Ferric carboxymaltose
  • Iron deficiency
  • Severe anemia
  • Transfusion

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

Cite this

Treatment with ferric carboxymaltose in stable patients with severe iron deficiency anemia in the emergency department. / Motta, Irene; Mantovan, Giulia; Consonni, Dario; Brambilla, Anna Maria; Materia, Maria; Porzio, Marianna; Migone De Amicis, Margherita; Montano, Nicola; Cappellini, Maria Domenica.

In: Internal and Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "The AABB Choosing Wisely Campaign recommends “don’t transfuse for iron deficiency without hemodynamic instability”. However, the management of iron deficiency anemia (IDA) in the emergency department (ED) is heterogeneous and patients are often over-transfused. Intravenous iron is effective in correcting anemia and new formulations, including ferric carboxymaltose (FCM), allow the administration of high doses with low immunogenicity. The aim of this retrospective study was to analyze the management of hemodynamically stable patients aged 18–55 years with severe IDA (hemoglobin < 8 g/dL), who presented to the ED from January 2014 to July 2018. Patients who received FCM (FCM1) and those who did not receive FCM (FCM0) were compared. Efficacy and safety of FCM at follow-up were evaluated. Seventy-one subjects fulfilled the inclusion criteria (FCM0 n = 48; FCM1 n = 23). The mean Hb at admission was 6.6 g/dL. 40{\%} in the FCM0 and 13{\%} in FCM1 were transfused (p = 0.02). 21{\%} of FCM0 patients were admitted to the ward, while all FCM1 were discharged (p = 0.02). Within 2 weeks, the Hb increase was 2.8 ± 1 g/dL in the FCM1 group. Sixteen FCM1 patients were evaluated at 52 ± 28 days (median 42, range 27–122): the average Hb increase was 5.3 ± 1.4 g/dL. In summary, we showed that FCM administration in the ED in hemodynamically stable patients was associated with fewer transfusions and hospital admissions compared to the FCM0 group; moreover, it succeeded in safely, effectively and rapidly increasing Hb levels after discharge from the ED. Further studies are needed to develop recommendations for IDA in the ED and to identify transfusion thresholds for non-hospitalized patients.",
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