IV Iron Versus Standard Treatment for Iron Deficiency Anemia in the Emergency Department
Condition: Iron Deficiency Anemia Treatment; Iron-deficiency; Iron Deficiency Anemia Due to Blood Loss; Iron Deficiency Anemia
MeSH terms: Anemia; Anemia, Iron-Deficiency; Iron Deficiencies; Deficiency Diseases; Emergencies
Study type: Observational

Summary: 
      The investigators will retrospectively collect data of patients infused at UMC's emergency
      department (ED) with long acting irons (ferric carboxymaltose, iron dextran, iron sucrose,
      etc.), in addition, patients infused with blood products, with intent to treat iron
      deficiency anemia (IDA). Patient records reviewed will be from patients who were infused at
      UMC ED from January 2013 to June 2018. Primary aim of analysis will be to investigate
      superiority between interventions implemented for treating IDA. In addition, the
      investigators will utilize data to characterize patients who used ED services as an avenue to
      receive treatment for IDA. Further, the investigators will conduct cost analysis between
      different IDA directed treatments administered in the ED at UMC.
    

Detailed description: 
      Background:

      Iron deficiency anemia (IDA) is a condition that impacts approximately 2-billion people
      globally, and impacts individuals from all socioeconomic backgrounds, making it one of the
      most common nutritional disorders in the world. In any population, women and children are the
      groups that are more susceptible to suffering from IDA [3]. IDA has broad influences on the
      health of an individual, ranging from cognitive decline to motor deficits. When coupled with
      pregnancy, IDA has been shown to be associated with low birth weight and carries an increased
      risk of maternal and perinatal mortality. In addition to women and children, the prevalence
      of IDA has been found to increase with age, and with chronic disease. The approach to
      treating IDA regularly begins with oral iron supplementation. However, due to increased
      gastrointestinal side effects or excessive losses of iron, intravenous iron has been shown to
      be better tolerated. Further, intravenous iron is another attractable iron replacement
      strategy in IDA when the need for rapid delivery is required, such as in pregnancy or
      following traumas. When compared to blood products, intravenous iron is an attractive option
      due to its ready availability. With a growing and aging population it is important that major
      health problems such as IDA be investigated further in order to identify sustainable
      therapeutic strategies.

      Benefits of Study:

      This retrospective study will provide the investigators with valuable knowledge on which
      treatment for IDA may be most effective in treating our El Paso population of patients
      suffering from IDA (Primary Aim). This study will also allow the investigators to identify
      which IDA treatment is most cost effective (Secondary Aim A), and which population of the
      community would benefit the most from an outpatient infusion service (Secondary Aim B).

      Chart Inclusion Criteria:

      All patients receiving one IDA intervention in the UMC ED who had at least one complete blood
      count or hemoglobin after discharge from the emergency department or hospital.

      Exclusion Criteria:

      Patients with no records of follow up.

      Identification:

      Collection of Patient Records and Data: Patient records reviewed will be from patients who
      were infused at UMC ED from January 2013 to June 2018. The age group of patients will be
      those greater than 18 years of age. The investigators will include all patients presenting to
      or treated at UMC ED during this five and one-half year period. Patient information such as
      unique identifiers (e.g. medical record number, hospital account number) will be used to
      navigate patient records for approved research personnel only. No procedures will be
      performed as part of this study. All data will be collected as a retrospective chart review.
      The investigators will access patient data through both UMC and Texas Tech electronic medical
      records as patients who received an intervention may have received follow up in a Texas Tech
      clinic rather than the UMC emergency department. The only risk of this study is the potential
      for loss of confidentiality. Research personnel will take extra measures to reduce this risk.
      The researchers will not publish any data that can be used to identify the patient, such as
      but not limited to personal or unique identifiers, medical record numbers, hospital account
      numbers or date of birth.

      Experiment group:

      Patient charts will be identified through digital records of UMC pharmacy and UMC blood bank.
      Patients included, will be those listed to have IDA by set criteria [Listed below], and who
      were treated with at least one IDA intervention other than blood product transfusion. Control
      group will be formed using patients who received at least one IDA intervention using blood
      product transfusion only. The investigators will attempt to match charts by age, condition
      leading to IDA, and gender in final analysis.

      Set criteria:

      Patient charts will be identified if they were the recipient of listed blood and bloodless
      transfusion products for treatment of IDA.
    

Intervention name(s): Packed red blood cells; Intravenous drug
Intervention type(s): Biological; Drug
Intervention description(s): Standard treatment for iron deficiency anemia (control); Experimental treatment for iron deficiency treatment
Other intervention name(s): PRBC; Intravenous iron
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with iron deficiency anemia treated with intravenous iron or packed red blood
        cells
      
Keywords: iron deficiency anemia