Red cell transfusions over-used in iron-deficiency anaemia


By Tony James

20 Oct 2015

Red cell transfusion continues to be over-used as a ‘Band-Aid’ solution to treat iron deficiency anaemia with insufficient longer-term efforts to supplement iron stores, Dr Kathryn Robinson, from the Queen Elizabeth Hospital in Adelaide, told delegates.

Dr Robinson said doctors should focus on treating their patients, not just their laboratory results. She was delivering the Ruth Sanger Oration, recognising the Australian-born haematologist who played a pivotal role in understanding blood groups.

“Red cell transfusion is potentially hazardous, expensive, and doesn’t replenish deficient iron stores,” she said.

“The cost of a transfusion is about the same as a bottle of Grange Hermitage, and the bottle of Grange may benefit the patient more than the over-use of red cells.”

Studies in Australia have shown that when patients with iron deficiency anaemia were admitted to hospital for a transfusion, earlier opportunities to address their deficiency had been missed and many were not prescribed post-transfusion iron supplementation.

Dr Robinson stressed that oral iron supplementation is often problematic.

“There are more than 150 iron supplements on the market in Australia, but many are at sub-therapeutic doses, for example 5 mg. We also know that advice from pharmacists about dosing is often incorrect.”

Intravenous iron is a very effective therapy and it has been facilitated by the availability of ferric carboxymaltose, delivered by a 15-minute infusion and with a lower risk of adverse effects than older preparations. The product is indicated for patients with iron deficiency when oral preparations are ineffective or not tolerated.

Dr Robinson has been instrumental in educating health care professionals about the appropriate and safe use of blood products through the South Australian ‘BloodSafe’ program.

An e-learning program on transfusion which she helped develop was completed by 170,000 people last year, bringing the cumulative total of users to more than 500,000.

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