Background Anaemia is common amongst patients receiving specialist palliative care. A 2003 study of palliative care patients found that 77% of men and 68.2% of women were anaemic (Dunn, Carter & Carter, 2003. J Pain Symptom Manag. 26: 1132). This study identified that patients with both malignant and non-malignant disease were found to have moderate-severe anaemia (Dunn, Carter & Carter, 2003). In addition, a national audit performed in 2019 found that 12% of cancer patients receiving blood transfusions may have benefitted from B12 injections and 41% may have benefitted from folate (Neoh, Gray, Grant-Casey, et al., 2019. Palliat Med. 33: 102). An initial audit at Mountbatten in November 2021 demonstrated that 53% of patients receiving blood transfusions had anaemia with an identifiable reversible cause.
Method Retrospective data was collected from patients for whom a full blood count blood (FBC) sample was sent to the local pathology laboratory over a 6 month period. Results for FBC and haematinics were reviewed along with the clinical notes to review actions taken.
Results A total of 171 FBC requests were made in a 6 month period, 129 results returned an abnormal Hb result. A random sample of 18 patients was evaluated; all with a haemoglobin (Hb) less than normal for gender but greater than 80g/L. 50% of these patients had a Hb between 80-100g/L. Of these patients 44% had a full haematinic profile available (taken 3 months prior or 4 weeks after low Hb result). But of the total patients reviewed (Hb <normal for gender) only 25% of patients had a full haematinic profile available. Of the four patients with full haematinics available three required no further action and one had appropriate prescriptions issued.
Conclusion Only investigating 25% of cases means we are likely missing a group of patients for whom reversible causes of anaemia can be treated. This audit has changed our practice at Mountbatten Hampshire. We will now be requesting full haematinics for all patients requiring an FBC.
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