Background Anaemia is common in palliative care. Treatment of iron deficiency, if present, is recommended to improve symptoms and reduce dependency on blood transfusion. Previously, use of intravenous iron has been limited by the risk of anaphylaxis, however newer preparations have greatly improved safety profiles. Despite this, the feasibility of their use in hospices is unclear.
Methods A policy for administering intravenous iron at Marie Curie Hospice Liverpool was developed as part of a project to improve the targeted treatment of anaemia. Retrospective review of electronic patient and laboratory records was performed for patients receiving the intervention between October 2018 and July 2019. In all cases a single dose of Monofer (iron (III) isomaltoside) was given in keeping with the product literature.
Results 12 infusions were given to 10 patients. 4 were inpatients, the remainder day cases. Mild extravasation occurred in one case, leading to discolouration but no pain. There were no other adverse reactions. 30, 60 and 90-day survival was 92%, 92% and 58% respectively. Baseline haemoglobin was 80 g/L in 6 cases, 80–100 in 3 and >100 in 3. All met recommended criteria for diagnosing iron deficiency in cancer (ferritin <100ug/L and transferrin saturation <20%). Fatigue was documented for all, alongside breathlessness in 4 and bleeding in 2. 6 patients had received transfusions within the previous 3 months. Iron was given alone in 8 cases, none required subsequent transfusion. Transfusion was performed in addition to the iron infusion in 4 cases, 3 requiring further transfusions, although two had apparently decreased frequency to previously.
Conclusion This case series demonstrates the feasibility of using intravenous iron, within its product specification, to treat iron deficiency anaemia in a hospice setting. Research is required to confirm the efficacy and optimum targeting of this approach in palliative care populations.
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