to benefits of iron infusions
Dr. Ryan Lett By Girard Hengen Regina anaesthesiologist Dr. Ryan Lett thought he had kept on top of developments in his field. He read the literature, studied the journals. But a trip to an international conference proved to be enlightening for Dr. Lett, who learned of an innovative alternative to blood transfusions. Using IV iron infusions, instead of blood transfusions, exposes patients to less risk and would result in significant cost savings for the health-care system, Dr. Lett said. “It’s becoming the standard of care around the world. In stable, anemic patients the evidence suggests that intravenous iron is among the best hematinic agents available.”
IT’S BECOMING THE STANDARD OF CARE AROUND THE WORLD ... THE EVIDENCE SUGGESTS THAT INTRAVENOUS IRON IS AMONG THE BEST HEMATINIC AGENTS AVAILABLE.
Dr. Lett learned about IV iron infusions at the 16th World Congress of Anaesthesiologists in Hong Kong last summer. The procedure is more common in Europe and Australia, but is not so well-known in his home province. “I showed up and I actually thought I was up to date on everything, I didn’t expect to get much out of the meeting thinking I had read enough journals to keep up on everything,” he said of the congress. “When I came back I started reviewing some of the articles and literature that had been mentioned – and it’s in all of the major medical journals –
when you start looking, the preponderance of evidence supports preventative iron infusions where possible, and even treatment IV iron infusions when the patient is stable, being superior to blood transfusion.” Many patients can be better prepared for surgery by using IV iron treatments to increase hemoglobin. Through this process, patients make their own hemoglobin so that by the time of surgery, they are much less likely to require a risky blood transfusion. “There’s a host of reasons for not wanting to get a blood transfusion,” said Dr. Lett, citing risks such as increased chance of mortality, increased length of hospital stays, stroke, heart attack, infection and transfusion reactions. Cost is also a consideration. Dr. Lett analyzed a cohort of 250 anemic patients in Saskatchewan needing surgery. To treat every patient’s anemia by blood transfusion would cost the province $196,000, but using IV iron would cost $60,000 – a savings of more than $130,000. Another study performed by the Saskatchewan Transfusion Medicine Working Group found that at least 20 per cent of units of blood were given to stable, non-bleeding patients with hemoglobin levels greater than 70g/L. Dr. Lett said while that may seem insignificant, when applied to the 31,000 units of red cells transfused in the province every year, the cost savings if the blood was not given would amount to $2.6 million per year, not including the costs of complications and increased hospital stay in those patients receiving blood. Dr. Lett says blood transfusions are a habit and habits are hard to change. There will always be a need for transfusions, but if there is to be a shift to greater use of iron infusions, it won’t be easy and it won’t be quick. “The more you learn the more it becomes a possibility that transfusion might actually be replaced (by IV iron) in patients who are stable and are not bleeding.” ◆ SMA DIGEST | SPRING 2017