Iron deficiency anaemia is the most common cause of anaemia. Parenteral iron therapy in the UK has to be administered in hospital settings as it comes with risk of allergic reactions and anaphylaxis. Clear procedures should be established in each hospital to ensure that parenteral iron therapy is prescribed according to the national guidelines ans audited regularly.
The aim of this audit was to estabilish if if the diagnosis of iron deficiency was performed according to the guidelines and if patients were adequately monitored after receiving parenteral iron.
Pharmacy provided the list of IV iron prescriptions issued in a period of 12 months. A clinical audit was performed to understand if patients had a documented diagnosis of iron deficiency (low haemoglobin, low ferritin or low transferrin saturation according to the local laboratory ranges); if there was a follow up blood test including the same parameters and if patients who were still iron deficient were prescribed further iron.
A total of 233 prescription for 227 patients were analysed. Of those 99% had a blood test previous to the iron infusion (99% had full blood count, 94% had ferritin level, 63% had transferrin saturation). Only 80% of patients had confirmed iron deficiency, in 2 % of the patients there was no iron deficiency and in 1 patient there were laboratory signs of iron overload, in the remaining 18% iron status was incomplete as transferrin saturation was not performed.
Follow up was missing in 16% of the cases, in 66% of the patients was done between 2 weeks and three monts, in 20% of the cases after that. All the patients had full blood count, only two thirds had ferritin level done and less than a quarter had transferrin level done. Thirty nine patients (17% o) were found to be still iron deficient but only a fifth of them received further iron therapy. Only 10% had normal iron studies, in the remaining cases iron status was not evaluable.
Several issues were identified that will require improvement. First of all we found that some of the prescriptions were unnecessary (2%) or controindicated (0.5%). In a fifth of the cases as iron studies were incomplete, was not possible to establish of the therapy given was appropriate. The main problem was lack of follow up or follow up with incomplete iron studies that made impossible to interpret the iron status in tre quarter of the patients, and missed iron therapy in five out of six patient with documented iron deficiency. Resolving these problem, as they are not isolated to a single department, will be a challenge. Solutions should be found to ensure that there are no inappropriate parenteral iron prescriptions and that patients are monitored adequately and given further therapy when required. Establishing an iron deficiency service to monitor patients could be one of these solutions, but it will require major institution re-organisation.