Inpatient Iron Deficiency Detection and Management: How do General Physicians and Gastroenterologists perform in a tertiary care hospital?

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Inpatient Iron Deficiency Detection and Management: How do General Physicians and Gastroenterologists perform in a tertiary care hospital?

Intern Med J. 2017 May 16;:

Authors: Fazal MW, Andrews J, Thomas J, Saffouri E

Abstract
BACKGROUND: Iron deficiency (ID) is often an indicator of underlying pathology. Early detection and treatment avoids long term morbidity, and allows for prompt iron repletion avoiding ID anaemia (IDA) and need for blood transfusion.
AIM: We aimed to evaluate the management of ID in two internal medicine units [General Medical (GM) & Gastroenterology (GE)] in a large metropolitan hospital and compare it to international guidelines.(3,4) METHOD: All consecutive inpatient admissions under GM & GE units were retrospectively reviewed until 40 patients in each service were identified with anaemia and/or microcytic hypochromic blood counts. Patient records and electronic discharge summaries were then reviewed to assess the recognition, investigation and management of these abnormalities.
RESULTS: Overall, only 60% (48/80) of the cases of microcytic hypochromic picture +/- anaemia were recognised. Cases were more likely to be detected under the GE unit; 77.5 % [31/40] vs 42% [17/40] in GM (p < 0.002). Of the 31 recognised GE cases, 28 (90%) were investigated further with iron studies and/or endoscopic procedures. ID was confirmed in nearly half (5/11) those tested, however only 2/5 received iron replacement. Among GM patients, only 11 of the 17 recognised cases (64%) were investigated further. Iron studies were performed in all 11, confirming IDA in 4 (36%), all of whom received intravenous iron. Faecal Human Haemoglobin test was performed in 2 GM and 1 GE patients.
CONCLUSION: There remains significant room for improvement in recognition, investigation and management of iron deficiency in hospital practice in Australia.

PMID: 28509435 [PubMed - as supplied by publisher]

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