Marina Baskharoun, MD, Sara Goff, MD, Frank Friedenberg, MD, MS
Temple University School of Medicine, Philadelphia, PA
Introduction: A common cause of iron (Fe) deficiency anemia (IDA) is gastrointestinal bleeding (GIB). While treatment is aimed at the underlying cause of IDA, it is also targeted at replenishing Fe stores to reduce anemia progression and end organ damage. Our objective was to assess whether patients hospitalized with IDA secondary to GIB received appropriate Fe supplementation upon discharge and the effect of this therapy post-discharge.
Methods: Retrospective review of patients hospitalized with GIB between 1/2017 and 12/2017. Patients eligible for Fe on discharge had one or more of the following: ferritin ≤ 30, Fe saturation ≤ 10%, and/or ≥ 2-gram decrease from the patient’s baseline hemoglobin (hgb) with a final hgb of < 10.0 due to GIB. We excluded patients with active malignancy, prior abdominal surgery, hematologic disorders, hgb > 10 on discharge, or died during hospitalization. We recorded the hgb on admission, nadir, and discharge and whether blood transfusions and Fe supplementation were given. In addition, use of anticoagulants and antiplatelet agents prior to admission was recorded. A post-discharge period of 180 days was used to assess outpatient hgb levels and hospital readmission. A regression analysis was performed to identify significant variables associated with receiving appropriate Fe supplementation on discharge.
Results: From 992 records, 228 patients met inclusion criteria. There were 115 M, 113 F, with a mean age of 62.6y. Overall, 106 (46.5%) patients received Fe on discharge. In regression analysis, adjusted for multiple confounders, having received Fe (PO or IV) while inpatient was strongly predictive of receiving Fe on discharge aOR= 13.5 (CI 6.8-26.8). In addition, if admission hgb was < 8.0, the aOR of receiving Fe on discharge was 2.21 (CI 1.10 – 4.45). Nadir and discharge hemoglobin were not associated with Fe supplementation. There was no statistical reduction in readmission rates for those discharged on Fe although a Type 2 error could not be excluded.
Discussion: Physicians fail to provide Fe supplementation on discharge to over 50% of patients eligible after a GIB. Fe supplementation during a patient’s hospitalization is the strongest predictor of receiving Fe upon discharge. This may be due to the medication reconciliation performed by the EMR at time of discharge. The other predictor variable was admission hgb but not nadir or discharge hgb. Automated reminders built into the EMR may help reduce this widespread problem.
Citation: Marina Baskharoun, MD, Sara Goff, MD, Frank Friedenberg, MD, MS. P1303 - PHYSICIANS FAIL TO UTILIZE IRON SUPPLEMENTATION AFTER DISCHARGE IN GASTROINTESTINAL INTESTINAL BLEEDING. Program No. P1303. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.