Splenic hematoma is a relatively benign condition in consideration that a majority are spontaneously absorbed. Rarely, they can become infected, a condition that is difficult to diagnose and is associated with significant morbidity and mortality if left untreated. We present a patient with a known history of intravenous drug abuse and recent abdominal trauma who was found to have infective endocarditis and subsequently an infected splenic hematoma. The related literature is also discussed.

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5140 Introduction: Folic acid (FA) deficiency is considered one of the important causes of anemia and of neural tube defects in infants. In 1996 FDA issued a regulation that by 1998 all enriched grain products contain 140 mg of folic acid per 100 grams. This process began in 1996 and was essentially completed by mid-1997. This program intended to increase folic acid intake among women of childbearing age has decreased the incidence of pregnancies affected by neural tube defects. This has also led to a decrease in incidence of FA as a cause of anemia. In 2000 we reported the impact of folate food fortification in our community hospital. In 1994 to 1996, of 4403 patients sample tested 60 were found to be folate deficient. From 1997 to 1999 only 3 of 6326 patients tested were folate deficient. The first patient was 73 year old and had severe CHF and COPD, the second patient was 62 year old alcoholic admitted with delirium tremens, and third patient was 90 year old with dysphagia who required PEG replacement. All three appeared to have stopped eating in the days prior to admission. On the basis of this experience in our community hospital we concluded at that time that folate food fortification has largely eliminated FA deficiency and that the routine determination of FA as part of anemia work up in this era is not indicated. We now report our continuing experience from 2003 to 2006. Methods: We studied retrospectively the patients who presented in our community hospital with anemia and folate level ordered as a part of anemia work up. Serum folate levels were measured using Bayer Center Chemiluminescent Assay. Serum FA level <1.1 mg/ml is considered indicative of deficiency. We evaluated 1861 patients from year January'2003 to May'2006. We also assessed the cost effectiveness of ordering this test routinely as part of anemia workup. Results: Among the 1861 patients, we did not find any patient who had folate level of less than 1.1, which is the lower limit for folate level in our laboratory. Medicare cost for serum folate level test for our institute is $20.54 (code 82746) and phlebotomy cost for one test is $3.00 (code 36418). Total cost for this test for one patient is $23.54. Total health cost for these tests in 3 years and five months was $43807.94. Conclusion: Our results which are similar to our previous report suggest that food fortification and possibly also vitamin supplementation has substantially improved blood folate levels and has largely eliminated folic acid deficiency as a cause of anemia in the population that we tested. Routine folate level determination in the workup of anemia is not cost effective and may be best limited in patients who are malnourished as in patients with poor nutrition status, malabsorption, alcoholics and psychiatric disorders. Disclosures: No relevant conflicts of interest to declare.

4229 Introduction: Patients with iron deficiency anemia (IDA) who need intravenous iron are normally treated with iron dextran. One of the major side effects of iron dextran is severe (sometimes fatal) anaphylactic reaction, which can develop in about 1% of patients. On the other hand, iron sucrose (Venofer®) another intravenous iron preparation that has improved safety and ease of administration. This preparation is being used in dialysis patients with very good results. But this has never been formally evaluated in non-dialysis-dependent patients. In view of these issues with iron dextran, some non-dialysis dependent patients in the Hematology/Oncology clinic at Coney Island hospital with IDA who needed parental iron therapy for IDA (due to intolerance or poor response to oral iron) were offered treatment with Venofer®. Our study is done to assess the response of intravenous iron therapy Venofer® in non-dialysis dependent patients with IDA. Methods: Consecutive patients who were treated with Venofer® for IDA in the Hematology/Oncology clinic in Coney Island Hospital, Brooklyn, New York, USA were obtained medical records. The number of cases included in the study was 42. Charts of these patients were reviewed and key data were collected before the start of treatment and weekly after starting the treatment. Response was defined as an increase in the hemoglobin level of 2 g/dl or greater after starting the treatment. At the same time, the reason for starting the IV iron therapy and the toxicity associated with treatment was evaluated. The paired t test was used to assess hemoglobin response. Results: Patients received 200 mg by of Venofer® by slow IV push every week. Analysis showed that 35 out of 42 patients (83.3%) received 4 doses. The mean increase in hemoglobin level after 4 doses was 1.65±0.98 g/dl (P=0.00002). 7 out of 35 patients achieved increase of 2 g/dl or greater in hemoglobin level (response rate of 20%). 13 out of 42 patients (30.9%) continued to receive Venofer® up to 8 doses. The mean increase in hemoglobin level after 8 doses of treatment was 2.66±1.73 g/dl (P=0.00001). 11 out of 13 patients who received 8 doses achieved a hemoglobin increase of 2 g/dl or greater (response rate of 84.6%). Indications for starting IV iron for 12 patients was intolerance to oral iron due to GI side effects, for 24 patients it was no response with oral therapy, for 3 patients it was general malabsorption and other 3 patients due to non-compliance. Among all the patients studied, none had any complications related to intravenous iron. Background: Our data showed that intravenous the iron prepration, Venofer®, which is currently not the standard of care for treatment of IDA in non-dialysis-dependent patients has very good response (response rate of 20% after 4 cycles and 84.6 % after 8 cycles). It is well tolerated and has no major side effects. More studies needs to be done with larger number of patients, with attention to both medical and economic impact, before this can become a stanadard of care for non-dialysis-dependent patients with IDA, who do not respond or have intolerance to oral iron preprations. Disclosures: Off Label Use: Venofer® for iron deficiency anemia in non-dialysis dependent patients.