1. Intravenous Iron in Palliative Care
Dr Wynitia Jones
F2 Y Bwythyn Newydd, Bridgend

2. Content
Introduction
Methods
Results
Discussion
Questions

3. Introduction Anaemia is common and multifactorial
Blood transfusions are widely used
A proportion of patients will present with iron deficiency anaemia
Could iron infusions be a transfusion alternative?

4. Cost
£ for 1 unit
£7.97 per 2mL amp
(100mg)

5. Methods Literature search
Case-note review of the last 20 patients who had blood transfusions
establish how many had an iron-deficient picture
Telephone survey across Wales
how many are offering iron infusions
Forums

6. Results: Case-note Review
20 notes reviewed
8 still alive
12 deceased
Mean survival: 4.5 months
Median survival: 4 months
Range: 1 – 19 months
IV Iron raises Hb by 1-2grams/week
i.e. patients are surviving long enough to feel the benefits of IV iron

7. Breakdown of the FBC

8. Patients with Microcytic Anaemia
Primaries: breast, colon, lung, prostate
3 = cancer related 1 = chemo related
2 did not require subsequent transfusions

9. Results: Telephone Survey
9 Inpatient units
3 oupatient units
2 community based units
11 units offered a blood transfusion service
Very little use of IV iron across Wales

10. Results: Literature Search
Improved side effect profile for low molecular weight iron dextran
Lots of evidence for patients who are receiving erythropoeitic-stimulating agents having chemo
I was unable to find evidence for our subset of patients

11. Results: Forums Dr Dean Blackburn
“……the drive locally is very much to identify and treat all those with iron deficiency as a way of reducing overall blood requirements”
”Ferinject is a new one off treatment for Iron Deficiency (Not needing 6 or more doses like Venofer). No anaphylaxis potential, significantly more expensive but much cheaper than blood.” 

12. Diagnosis of Anaemia Identify iron deficient patients
Microcytic indices are not diagnostic
Normally comment on serum ferritin
Consider looking at the total iron binding capacity

13. Evaluation Strengths Weaknesses Extensive literature search
Limited number of patients assessed
Established an impression of practice throughout Wales
Telephone survey results difficult to interpret
Used a range of sources
New communications that need follow up

14. Discussion Very small population of patients
Is this too small to change practice?
Careful diagnosis is required
Slower to raise Hb – may require a change in follow up

15. Potential to be cost effective
Improved side effect profile
Reduce the number of day hospital attendances
Used elsewhere successfully

16. Thank you for listening!
Any questions?
Thank you for listening!