ABSTRACT
Background: Anaemia and iron deficiency affect a high proportion of patients with cancer, especially when undergoing treatment with systemic anti-cancer therapies (SACT) and are associated with fatigue, reduced quality of life & reduced performance status. Over the past 4 years, the Oncology DTU has continuously reviewed the managment of patients with anaemia and in particular the need to diagnose iron deficiency at time of starting SACT and recently the same guidance were introduced for Haemato-Oncology patients. Routine blood testing of Transferrin Saturation (TSAT) and serum ferritin is performed on all patients at time of starting SACT, those diagnosed with iron deficiency anaemia are treated with an intravenous iron infusion. During this time, various logistical challenges, learning and updates to local guidance has led to a more robust process, now in place to manage this patient group. Methods: Cancer patients attending for cycle 1 day 1 SACT have their TSAT and serum ferritin levels measured, if diagnosed with iron deficiency (ie TSAT <20% and serum ferritin <100ug/L, patients will receive an intravenous iron infusion. In March 2022, an audit of 141 new oncology referrals for SACT and 11 patients who received a blood transfusion was conducted for compliance to local guidance. Results: Logistical challenges included: update and approval of local guidelines, education of all members of the Health Care Team re: prescribing, contraindications and side-effects of iron infusions, patient education. Wider issues, include: COVID, staffing. 129/141 patients had TSAT and serum ferritin levels checked, of these 57 patients were diagnosed as iron deficient, with 54 patients then receiving an iron infusion. Analysis of further results is still underway. Conclusions: Whilst this is a very small audit, it demonstrates the importance of considering iron deficiency as an underlying cause of anaemia in patients with cancer, who are starting SACT and can ensure patients receive the most appropriate supportive treatment for their needs. Through our experiences, with the support of our haematology consultant, this service is predominantly nurse led and continues to develop. Legal entity responsible for the study: The author. Funding: Has not received any funding. Disclosure: The author has declared no conflicts of interest.
ABSTRACT
Background: Blood transfusions are common medical practice in the UK, with approximately 2.1 million blood products being issued by UK blood serices in 2020. The Serious Hazard of Transfusion (SHOT) scheme reported that the risk of death and serious harm related to transfusions was 1 in 53,193 and 1 in 15,142 in 2020, respectiely. Multiple complications can occur as a result of blood transfusions, with the most common cause of death being Transfusion Associated Circulatory Oerload (TACO). Although low risk, there has been an increase in deaths related to blood transfusions from 17 deaths in 2019, to 39 deaths in 2020, in the UK, with 81.6% of aderse reactions and eents being due to preentable errors. This stresses the importance of safe transfusion practice. Aims: To reiew the rates of blood transfusions from 2013 to 2021, and compare our adherence to NICE guidance. We analysed rates of transfusion, number of red blood cells (RBC) units per transfusion, haemoglobin leels and the incidence of iron deficiency anaemia (IDA) prior to transfusion. Methods: Data was collected retrospectiely from patients' records and the transfusion laboratory database at Surrey and Sussex healthcare Trust. Adults (>16 years old) who receied inpatient or outpatient RBC transfusions from 2013 to 2021 were included (n = 53,941). We looked in further detail at the RBC transfusions from the first 2 weeks of December from 2014 to 2021 (n=546). Results: Figure 1 shows that there has been a significant decline in the number of RBC transfused from 2014 to 2021;an aerage gradient of -36.25 units per year (R2= 0.72). There has also been a decline in the aerage number of units per blood transfusion, with a downward trendline (gradient -0.15 RBC units/year, p= 0.001). There has been a significant increase in the percentage of single unit transfusions from 14% in 2014 to 65% in 2021;the trendline has a gradient of +7% / year (p=0.0009). The aerage haemoglobin at initiation of transfusion has remained relatiely unchanged (69-78g/L), which is in line with NICE guidance. There is no improement in transfusion of patients with IDA;defined as a low transferrin saturation (<20%). The percentage of these patients being transfused arying from 43% to 79%, with no significant trend oer the years from 2014 to 2021 (p=0.71). Summary/Conclusion: The total number of RBC transfused has significantly decreased oer 9 years. Howeer, there is a slight rise from August 2020, which may hae been a result of expansion of the Hospital bed base from 697 to 800 between years 2018-2021. It also may hae been impacted by the COVID-19 pandemic. There is a decrease in the amount of RBC units transfused per patient. We are also encouraged to see a significant increase in the number of single unit transfusions, in line with NICE Guidance. We found there was no improement in the number of patients with IDA being transfused (aerage 64%). This indicates that, depending on the clinical scenario, some patients may be receiing unnecessary blood transfusions. They may benefit from receiing iron replacement as an alternatie treatment, thereby minimising exposing patients unnecessarily to the risks associated with blood transfusion. Appropriate management of IDA needs further work in the trust, and we hae initiated an IV iron serice oer the last 18 months to improe this. Limitations of this study include using two weeks of the year to extrapolate for each year and data may hae been skewed oer the last two years due to the COVID-19 pandemic.
ABSTRACT
OBJECTIVES: Mounting evidence links hyperinflammation in gravely ill patients to low serum iron levels and hyperferritinemia. However, little attention has been paid to other iron-associated markers such as transferrin. The aim of this study was to investigate the association of different iron parameters in severe COVID-19 and their relation to disease severity. SUBJECTS AND METHODS: This study involved 73 hospitalized patients with positive test results for SARS-CoV-2. Patients were classified into two groups according to symptom severity: mild and severe. Blood levels of anti-SARS-CoV-2 antibodies, interleukin 6 (IL-6), C-reactive protein (CRP), and iron-related biomarkers were measured. RESULTS: The results revealed a significant increase in IL-6, CRP, and ferritin levels and decreased transferrin and iron levels in severe COVID-19. Transferrin negatively predicted variations in IgM and IgG levels (P < 0.001), as well as 34.4% and 36.6% increase in IL-6 and CRP levels, respectively (P < 0.005). Importantly, transferrin was the main negative predictor of ferritin levels, determining 22.7% of serum variations (P < 0.001). CONCLUSION: Reduced serum transferrin and iron levels, along with the increased CRP and high ferritin, were strongly associated with the heightened inflammatory and immune state in COVID-19. Transferrin can be used as a valuable predictor of increased severity and progression of the disease.