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Inpatient iron deficiency detection and management: how do general physicians and gastroenterologists perform in a tertiary care hospital?
Author(s) -
Fazal Muhammad W.,
Andrews Jane M.,
Thomas Josephine,
Saffouri Eliana
Publication year - 2017
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13486
Subject(s) - medicine , iron deficiency , tertiary care , pediatrics , intravenous iron , blood transfusion , anemia
Abstract Background Iron deficiency ( ID ) is often an indicator of underlying pathology. Early detection and treatment avoids long‐term morbidity and allows for prompt iron repletion, avoiding ID anaemia ( IDA ) and the need for blood transfusion. Aim To evaluate the management of ID in two internal medicine units (general medical ( GM ) and gastroenterology ( GE )) in a large metropolitan hospital and compare it to international guidelines. Methods All consecutive inpatient admissions in the GM and GE units were retrospectively reviewed until 40 patients in each service were identified with anaemia and/or microcytic hypochromic blood counts. Patient records and electronic discharge summaries were then reviewed to assess the recognition, investigation and management of these abnormalities. Results Overall, only 60% (48/80) of the cases of microcytic hypochromic picture and/or anaemia were recognised. Cases were more likely to be detected under the GE unit, 77.5% (31/40) versus 42% (17/40) in GM ( P < 0.002). Of the 31 recognised GE cases, 28 (90%) were investigated further with iron studies and/or endoscopic procedures. ID was confirmed in nearly half (5/11) of those tested; however, only 2 of 5 received iron replacement. Among GM patients, only 11 of the 17 recognised cases (64%) were investigated further. Iron studies were performed in all 11, confirming IDA in 4 (36%), all of whom received intravenous iron. A faecal human haemoglobin test was performed in two GM patients and one GE patient. Conclusion There remains significant room for improvement in the recognition, investigation and management of ID in hospital practice in Australia.