Brownlee Thomas, Dersch-Mills Deonne, Cummings Ginny, Fischer Tanya, Shkrobot Rhonda, Slobodan Jeremy, Wichart Jenny
, BSP, ACPR, is with Red Deer Regional Hospital Centre, Red Deer, Alberta.
, BScPharm, ACPR, PharmD, is with Alberta Health Services - Pharmacy Services, Calgary, Alberta.
Can J Hosp Pharm. 2021 Winter;74(1):50-56. Epub 2021 Jan 1.
IV administration of iron is appropriate for the treatment of iron deficiency anemia (IDA) when orally administered iron has not been effective, tolerated, or clinically appropriate. In Calgary, Alberta, high levels of IV iron utilization required review, because of significant health care resource utilization, high cost, and reduced accessibility.
The primary objective was to describe the population of adult patients in Calgary with estimated glomerular filtration rate greater than or equal to 30 mL/min/1.73 m for whom IV iron was dispensed from acute care facilities, in terms of pretreatment laboratory data, previous use of oral iron, and treatment location, as well as to characterize dose and product selection for IV iron. The secondary objective was to determine the proportion of inpatients whose treatment was in alignment with the Toward Optimized Practice clinical practice guideline for IDA.
A retrospective review of electronic charts was used to obtain data about patients with a first dose of IV iron dispensed in Calgary hospitals between March 1 and December 31, 2018. The data were analyzed descriptively.
A total of 1352 patients met the inclusion criteria. These patients received a total of 3532 doses of IV iron, 97.1% of which were iron sucrose, at a median of 300 mg per infusion. Laboratory indices assessed before the first infusion were hemoglobin (mean 92, standard deviation [SD] 19.6 g/L), mean corpuscular volume (mean 81 [SD 10.3] fL), and ferritin (median 18 [interquartile range 9-48] μg/L). Among the included patients, 233 (17.2%) had oral iron dispensed within 90 days before their first IV dose of iron. Only 146 (20.1%) of the 726 inpatients had treatment that was in alignment with the Toward Optimized Practice IDA guideline.
There was substantial variation in baseline hemoglobin, mean corpuscular volume, and ferritin, and in the use of oral iron before initiation of IV iron treatment. Provision of educational tools and stewardship initiatives may help in ensuring alignment of iron prescribing with current guidelines.
当口服铁剂无效、不耐受或不符合临床应用情况时，静脉注射铁剂适用于缺铁性贫血（IDA）的治疗。在艾伯塔省卡尔加里市，由于大量医疗资源的利用、高昂的成本以及可及性降低，静脉铁剂的高使用量需要进行审查。
主要目的是根据治疗前实验室数据、既往口服铁剂的使用情况和治疗地点，描述卡尔加里市估算肾小球滤过率大于或等于30 mL/min/1.73 m²且从急性护理机构获得静脉铁剂的成年患者群体，并对静脉铁剂的剂量和产品选择进行特征描述。次要目的是确定住院患者的治疗符合IDA优化实践临床实践指南的比例。
采用回顾性电子病历审查，获取2018年3月1日至12月31日在卡尔加里市医院首次接受静脉铁剂注射的患者的数据，并进行描述性分析。
共有1352例患者符合纳入标准。这些患者共接受了3532剂静脉铁剂，其中97.1%为蔗糖铁，每次输注的中位数剂量为300 mg。首次输注前评估的实验室指标包括血红蛋白（平均92，标准差[SD]19.6 g/L）、平均红细胞体积（平均81[SD 10.3] fL）和铁蛋白（中位数18[四分位间距9 - 48]μg/L）。在纳入的患者中，233例（17.2%）在首次静脉注射铁剂前90天内曾接受口服铁剂治疗。在726例住院患者中，只有146例（20.1%）的治疗符合IDA优化实践指南。
在静脉铁剂治疗开始前，患者的基线血红蛋白、平均红细胞体积和铁蛋白以及口服铁剂的使用情况存在很大差异。提供教育工具和管理措施可能有助于确保铁剂处方符合现行指南。
