Steele Thomas, Bonwick Helen, Nwosu Amara Callistus, Chapman Laura
Marie Curie Hospice, Liverpool, Merseyside, L25 8QA, UK.
International Observatory on End of Life Care, Lancaster University, Lancaster, Lancashire, LA1 4YG, UK.
AMRC Open Res. 2021 Mar 22;3:6. doi: 10.12688/amrcopenres.12963.2. eCollection 2021.
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.
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.
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.
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.
贫血在临终关怀人群中很常见，且与严重的症状负担相关。指南建议对缺铁情况进行调查和治疗，但在姑息治疗人群中，几乎没有这种做法的证据。本报告描述了英国一家临终关怀机构对缺铁情况的调查结果及后续管理。
这是一项对常规临床数据的描述性研究。对2018年8月实施对有临床相关贫血且考虑进行治疗的患者进行缺铁常规调查后的12个月的实验室和临床记录进行回顾性审查。使用既定定义诊断绝对缺铁（AID）和功能性缺铁（FID），并记录治疗情况。
对112例患者的铁状态进行了评估，其中轻度贫血患者占25/110（22.7%），中度贫血患者占46/76（60.5%），重度贫血患者占41/54（75.9%）。28例（25%）被定义为患有AID，48例（42.8%）为FID，36例（32%）无缺铁。在触发血红蛋白检查和诊断的症状方面，各组之间存在显著差异，AID患者中出现贫血和胃肠道恶性肿瘤典型症状的患者比例更高。在临终关怀机构中，有12次给予静脉铁剂，未发生重大不良事件。观察到7例患者主观症状有改善，总体平均血红蛋白有统计学意义的升高。
本报告描述了英国一家临终关怀机构对临床显著贫血患者缺铁情况的调查结果。结果表明缺铁很常见，在临终关怀环境中，按照现行指南，静脉补铁治疗是安全的。进一步的研究应确定这种方法在姑息治疗患者中的最佳应用。
