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

Miguel Angel de las Nieves Lopez, Ana Maria Matas Cobos, Francisco Sarria Gonzalez, Maria Jose Dominguez Lome~na, Ana Maria Palomo Hernandez, Encarnacion Gil Gines, Salvador Serna Juan, Javier Ampuero Ampuero, Antonio Marin Fernandez, and Antonia Vazquez de la Villa

BACKGROUND: Anemia is the main indication for red blood cell (RBC) transfusion and iron deficiency is the most prevalent, preventable, and treatable cause of anemia worldwide. We aimed to assess the impact of iron deficiency anemia (IDA) on RBC transfusion by means of a program for prevention, early detection, and treatment.

STUDY DESIGN AND METHODS: A prospective observational study was conducted starting in 2014 after an intervention in clinical practice in Melilla, a peripheral city isolated by 207 km sea distance to nearest continental Spain. Recommendations were proposed for first-step diagnosis of iron deficiency in the laboratory, oral iron prevention and treatment in primary care, and intravenous iron complexes and RBC transfusion for hospital management. Reduction in RBC use for years 2014 to 2016 was the primary outcome, with the period 2010 to 2013 considered as baseline performance for statistical analysis.

RESULTS: Compared to baseline, there was a significant (p<0.05) increase in mean (6SD) yearly reference population (79,74863265 vs. 85,3766781), ferritin assays (69806997 vs. 11,79461567), admissions (67686239 vs. 76296191), and subjects exposed to iron therapy (397560.0 vs. 4667621 for oral, 5467 vs. 2576109 for sucrose, and 12869 vs.176615 for carboxymaltose iron). Mean yearly number of RBC units transfused decreased (16226112 vs. 1434644; p50.043), with a mean reduction of 11.6% from baseline, or 21.4% when estimated by units transfused per 1000 admissions.

CONCLUSIONS: 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.