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Value of a Preoperative Anemia Clinic in a High-Risk Obstetric Population
Abstract Number: SA-05
Abstract Type: Original Research
Introduction: Anemia during pregnancy, defined by the World Health Organization as hemoglobin (Hb)<11g/dL, affects up to 30% of pregnancies and is associated with significant maternal and fetal morbidity. The most common etiology of anemia is iron deficiency. Oral iron, the first line therapy, is poorly tolerated in the obstetric (OB) population due to GI side effects, and a recent systemic review showed intravenous (IV) iron to be more effective in treating iron-deficiency anemia of pregnancy.  Thus, obstetricians, OB anesthesia, and blood conservation at our institution collaborated to coordinate care for iron-deficient pregnant women, with the goal of improving anemia and reducing blood transfusions.
Methods: As of January 2015, patients at our High-Risk Obstetric (HROB) Clinic noted during routine screen to have iron-deficiency or other risk factor for transfusion, were referred to the Preoperative Anemia Clinic (PAC) for evaluation of anemia and consideration of IV iron. With IRB approval, we performed a retrospective review of patients referred from HROB to PAC from January to December 2015. Recorded date included initial Hb and ferritin at referral, number of iron infusions, Hb at delivery, time between referral and delivery, and peripartum blood transfusions. Significance of the Hb change was assessed by a Wilcoxon Signed Rank test, and the difference in Hb change between those that did and did not receive IV iron was assessed with a Wilcoxon Rank Sum test.
Results: 108 parturients were referred to the PAC. Of these, 77 (71.3%) received one dose, and 9 (8.33%) received two doses of IV iron. 22 patients missed their appointment, delivered prior to treatment, or opted for oral iron. Of all 108 patients, the mean (SD) Hb at referral was 9.45 (1.04) and the median (IQR) ferritin levels were 8.0 (6,14). The mean (SD) Hb at delivery was 10.55 (1.17), and the Hb increase was significant (median 0.9; IQR (0.4,1.7); P<0.0001). The median time from referral to delivery was 40 days. Of the 108 patients referred, 6.5% received a peripartum red blood cell transfusion.
Of the 86 patients who received IV iron, the median Hb increase from referral to delivery was significantly higher than that of the 22 who did not receive IV iron (1.0 vs. 0.55; P=0.0148).
Conclusion: This study shows that patients receiving antepartum IV iron had significantly greater increases in Hb level than those that did not. Further, a relatively low percentage of patients (6.5%) required blood transfusion, showing the value of referral of anemic parturients to a PAC.
1. McLean, E., et al., Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr, 2009. 12(4): p. 444-54.
2. Shi, Q., et al., Intravenous Iron Sucrose versus Oral Iron in the Treatment of Pregnancy with Iron Deficiency Anaemia: A Systematic Review. Gynecol Obstet Invest, 2015. 80(3): p. 170-8.