Investigation and management of iron deficiency anaemia in a specialist palliative care setting and the role of intravenous iron: a descriptive analysis of hospice data

AMRC Open Res. 2021 Mar 22:3:6. doi: 10.12688/amrcopenres.12963.2. eCollection 2021.

Abstract

Background: Anaemia is common in hospice populations and associated with significant symptom burden. Guidelines recommend investigating for and treating iron deficiency (ID), but there is little evidence of this practice in palliative care populations. This report describes the results of investigations for and subsequent management of ID in a UK hospice.

Methods: This is a descriptive study of routine clinical data. Laboratory and clinical records were reviewed retrospectively for 12 months following the implementation, in August 2018, of routine investigation for ID amongst patients with clinically relevant anaemia in whom treatment would be considered. Absolute (AID) and functional iron deficiency (FID) were diagnosed using established definitions and treatments recorded.

Results: Iron status was evaluated in 112 cases, representing 25/110 (22.7%) of those with mild, 46/76 (60.5%) moderate and 41/54 (75.9%) severe anaemia. Twenty-eight (25%) were defined as having AID, 48 (42.8%) FID and 36 (32%) no ID. There was a significant difference between groups in symptoms triggering haemoglobin check and diagnosis, with a higher proportion of patients with classic symptoms of anaemia and gastrointestinal malignancy in those with AID. Intravenous iron was given on 12 occasions in the hospice with no major adverse events. Subjective symptom benefit in 7 cases and a statistically significant increase in overall mean haemoglobin were observed.

Conclusions: This report describes the outcome of investigations for iron deficiency in patients with clinically significant anaemia in a UK hospice. Results indicate iron deficiency is common and can be safely treated with intravenous iron replacement, within current guidelines, in a hospice setting. Further research should define the optimum use of this approach in palliative care patients.

Keywords: Anaemia; hospice; intravenous iron; iron deficiency; palliative care.

Plain language summary

Many patients supported by hospices have anaemia. This means there is a reduction in the molecule, haemoglobin, which carries oxygen in the blood. Symptoms can include tiredness and shortness of breath. In severe cases, patients may be given a blood transfusion, however this carries significant risks and blood is a limited resource. Anaemia can be caused by a lack of iron. Iron deficiency can be treated with iron tablets or injections. However, iron tablets can have a lot of side effects and patients generally have to go to hospital for iron injections. There is little information about how important this is for anaemia that we see in hospices and how it should be treated. We looked at the results of tests for iron deficiency done at a UK hospice in day-to-day practice. The hospice started doing these tests for appropriate patients with anaemia after it was recommended in recent guidelines. Out of the tests performed, a quarter showed iron deficiency. There were a higher number of patients with typical symptoms of anaemia and patients with a cancer of the gut in the group with iron deficiency. We also looked at treatment given for iron deficiency. Twelve were given iron injections at the hospice, which hasn’t been reported before. This study was not designed to investigate how well this worked but there were no major side effects. It also seemed to improve blood counts and help symptoms in most. Overall, this study showed that we were able to test for iron deficiency at the hospice, we found it often and, in certain patients, were able to treat it with iron injections at the hospice. Research in the future should look at how we could best use this approach. It should also look at the effectiveness of iron injections in hospice patients.

Associated data

  • figshare/10.6084/m9.figshare.13577882.v1

Grants and funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. The roles of all of the authors are supported by Marie Curie.