Background Guidelines recommend the administration of intravenous (IV) iron to patients with anaemia due to iron deficiency. Blood transfusions are the last resource, advised only in critical patients, as they quickly raise haemoglobin (Hb) levels. However, they are also associated with deleterious outcomes.
Purpose We aimed to characterise the impact of blood transfusions in length of stay (LOS) and in-patient mortality, in a population of hospitalised anaemic patients treated with IV iron.
Material and methods This was a retrospective cohort study. Patient records from a Portuguese General Hospital, with at least one inpatient administration of iron sucrose (IS) in 2014–2015 or ferric carboxymaltose (FC) in 2016 (when FC became available), were reviewed. Adult anaemic patients with at least one Hb evaluation before and after the administration of IV iron were included. Endpoints assessed comprised the association of blood transfusions with LOS and in-patient mortality, adjusted for sex, age and baseline Hb level. Statistical analysis included a generalised linear mixed-effects model and logistic regressions, using a 5% significance level.
Results Data was collected for 1178 patients, of which 878 were treated with IS and 300 with FC. Mean age was 63.9 and 71.1 for patients treated with IS and FC, respectively. The majority of patients were female: 61.4% and 51.3% for the groups treated with IS and FC, respectively. Average baseline Hb level was 8.4 g/dl for both groups. The majority of patients required blood transfusions in both groups: 58.0% in the IS and 62.9% in the FC.
Receiving at least one blood transfusion increased the LOS by 21% (95% CI: 8 to 35) in the IS group and 28% in the FC group (95% CI: 3 to 60).
The in-hospital mortality risk increased 2.5-fold (95% CI: 1.4 to 4.3) in patients treated with IS and who received a blood transfusion. As for patients treated with FC, in-hospital mortality was 4.3 times (95% CI: 1.6 to 12.1) higher in patients who received a blood transfusion.
Conclusion Blood transfusions impacted adversely on patients’ outcomes across different groups. Therefore, blood transfusions should be carefully considered, in accordance with the most recent patient blood management guidelines.
Conflict of interest Corporate-sponsored research or other substantive relationships: this study was developed with financial support from Vifor Pharma. The authors had no restrictions or limitations during the study.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.