Prevalence of anemia among elderly patients in an emergency room setting

The AABB recommendations for the Choosing Wisely campaign of the American Board of Internal Medicine

“…In adults, one study estimated one‐quarter of transfusions for iron deficiency anemia were unnecessary and one‐third of patients did not receive oral iron on discharge . In elderly patients presenting to hospital with anemia, only one‐third undergo testing to determine if iron deficiency is a causative factor . The management of iron deficiency anemia with RBC transfusion is unfortunately all too common.…”

“…32 In elderly patients presenting to hospital with anemia, only one-third undergo testing to determine if iron deficiency is a causative factor. 33 The management of iron deficiency anemia with RBC transfusion is unfortunately all too common. One study reported that 39% of patients admitted to a tertiary care hospital with iron deficiency anemia were transfused.…”

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

“…Thus in most cases it is both safer and more cost-effective to correct iron deficiency, rather than to transfuse red blood cells. Despite this, observational data suggests that iron replacement is under-utilized in adult and pediatric settings, and that transfusion continues to be used unnecessarily as a first-line strategy for severe, but stable iron deficiency anemia [39][40][41].…”

Improving quality of care for patients with iron deficiency anemia presenting to the emergency department

“…A total of 193 units of RBCs were transfused by ED physicians to patients with IDA over the 24-month period. An average of 8 RBC units were transfused per month (range, [2][3][4][5][6][7][8][9][10][11][12][13][14], which constitutes 9% of total RBC units transfused in the ED. A total of 133 patients received RBCs, of whom 15 also received IV iron in the ED, and 78 received IV iron alone.…”

“…1,2 Despite this, studies in the geriatric and pediatric emergency department (ED) as well as the adult inpatient setting reveal that iron deficiency anemia (IDA) is not appropriately recognized, unnecessarily transfused, and not adequately treated with iron therapy. [3][4][5] Inappropriate red blood cell (RBC) transfusion in the ED leads to patients being placed at unnecessary risk of alloimmunization, transfusion reactions, and infections when safer alternatives such as oral or IV iron therapy exist. Overtransfusion decreases efficiency of patient care as the time required to administer an RBC transfusion is longer than an IV iron infusion (one dose of IV iron over 15 min to 2 hr).…”