University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Medicine, University of Florida, Gainesville, Florida, USA.
Transfusion. 2023 Sep;63(9):1685-1691. doi: 10.1111/trf.17502. Epub 2023 Aug 16.
Intravenous (IV) iron carries risks of mild, self-limiting, tryptase-negative Fishbane and complement activation-related pseudo-allergy reactions, with rare reports of anaphylaxis. Historically, high-molecular-weight iron dextran (HMWID) was associated with a higher incidence of anaphylaxis and empiric premedication with antihistamines/corticosteroids have been used to mitigate this risk. HMWID is no longer available and the risk of hypersensitivity reactions with newer IV iron formulations is low. Therefore, the use of routine prophylactic premedication in all patients is not justified but should be considered in high-risk patients.
Our primary aim was to reduce inappropriate premedication before IV iron administration by 50% so that our institution's hematology providers only prescribe premedications to patients at high risk of having a severe reaction. Interventions included a multidisciplinary education initiative to highlight current evidence against universal administration of premedications and revision of the IV iron informed consent form and electronic order set.
We measured the success of our intervention by comparing data collected during a 6-month pre-intervention period (837 infusions) to a 6-month post-intervention period (947 infusions). Inappropriate administration of premedications decreased from 79% in the pre-intervention period compared to 65% in the post-intervention period. We found no significant difference in the number of Fishbane reactions, severe reactions, and emergency room admissions, despite this reduction in premedication use.
Although we did not reach our goal of a 50% reduction in inappropriate premedication use, opportunities for process improvements were uncovered and are being explored in the next cycle of this quality improvement project.
静脉注射（IV）铁剂会引起轻度、自限性、无类胰蛋白酶 Fishbane 反应和补体激活相关假性过敏反应，极少数情况下会发生过敏反应。过去，高分子量铁葡聚糖（HMWID）与更高的过敏反应发生率相关，因此曾经验性使用抗组胺药/皮质类固醇进行预防用药来降低这种风险。HMWID 已不再使用，新型 IV 铁剂发生过敏反应的风险较低。因此，在所有患者中常规预防性使用预防用药是不合理的，但应考虑在高风险患者中使用。
我们的主要目的是将 IV 铁剂给药前不合理的预防用药减少 50%，使我们机构的血液科医生仅对有发生严重反应高风险的患者开具预防用药。干预措施包括一项多学科教育活动，以强调目前针对普遍使用预防用药的证据，以及修订 IV 铁知情同意书和电子医嘱集。
我们通过比较干预前 6 个月（837 次输液）和干预后 6 个月（947 次输液）的数据，来衡量干预的效果。不合理的预防用药使用率从干预前的 79%降至干预后的 65%。尽管预防用药的使用减少了，但我们未发现 Fishbane 反应、严重反应和急诊就诊数量的显著差异。
尽管我们未达到减少不合理预防用药使用 50%的目标，但在这个质量改进项目的下一个周期中，我们发现了改进流程的机会，并正在探索这些机会。
