Episode 65 – IV Iron for Anemia in Emergency Medicine

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 27 May 2015

⏱️ 67 minutes

🔗️ Recording | iTunes | RSS

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Summary

For years we’ve been transfusing red cells in the ED to patients who don’t actually need them. A study looking at trends in transfusion practice in the ED found that about 1/3 of transfusions given were deemed totally inappropriate. As we explained in previous EM Cases episodes, there have been a whole slew of articles in the literature over the years that have shown that morbidity and mortality outcomes with lower hemoglobin thresholds, like 70g/L for transfusing ICU patients (TRICC trial), patients in septic shock (TRISS trial), and patients with GI bleeds are similar to outcomes with traditional higher hemoglobin thresholds of 90 or 100g/L. We’re simply transfusing blood way too much! The American Association of Blood Banks in conjunction with the American Board of Internal Medicine’s Choosing Wisely campaign, as one of its 5 statements on overuse of procedures, stated, “don’t transfuse iron deficiency without hemodynamic instability”. So, in this episode with the help of Transfusion specialist, researcher and co-author of the American Association of Blood Banks transfusion guidelines Dr. Jeannie Callum, Transfusion specialist and researcher Dr. Yulia Lin, and 'the walking encyclopedia of EM' Dr. Walter Himmel, we give you an understanding of why it’s important to avoid red cell transfusions in certain situations, why IV iron is sometimes a better option in a significant subset of anemic patients in the ED, and the practicalities of exactly how to administer IV iron.

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases podcast.
0:05.8	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:16.0	And here's the walking encyclopedia of emergency medicine, Dr. Walter Himmel.
0:20.0	And if I arrive at a shift and one of my colleagues says,
0:22.6	this person is getting two notes of blood, I've got to control myself.
0:26.3	Because the first thing I want to say is, really.
0:29.4	And the huge researcher in transfusion medicine
0:32.0	and the head of transfusion medicine at Sunnybrook Hospital, Dr. Jeannie Callum.
0:36.2	Teach residents to try and fight back against the urge to transfuse 100% of patients
0:40.3	whose hemoglobin levels of low 70 because some of them just don't need it.
0:44.6	And last but not least, Dr. Yulia Lynn, another transfusion guru and researcher from
0:49.4	Sunnybrook Hospital.
0:50.9	With this podcast, we're actually influencing Emerge Docs to start considering being part of that
0:56.2	change.
0:58.7	So this really is sort of a revolutionary idea we're talking about here.
1:09.5	During the recording of episode 36 on transfusions, anticoagulants, and bleeding with Dr. Callum,
1:16.3	Dr. Caterina Pavensky, and Dr. Himmel, Dr. Callum introduced the idea of giving IV iron as a substitute
1:23.5	for red cell transfusions in the ED. Now, we hadn't planned on covering that topic, and so when I heard this, I turned to Walter,
1:32.3	and I noticed that his jaw was on the floor, as was mine.
1:36.9	You see, we'd never heard of anyone ever giving Ivy Iron in the ED, ever.
1:43.1	And Walter's been practicing for more than 30 years. This seemed like
1:46.4	a revolutionary idea to us. Then I started receiving emails from EMKAS's listeners who were
	...

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