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Striking the balance with intravenous iron: too much or never enough?
  1. Raphael Luber1,
  2. Esha Sharma1,
  3. Peter M Irving1,2,
  4. Mark A Samaan1
  1. 1Inflammatory Bowel Disease Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. 2School of Immunology and Microbial Sciences, King's College London, London, UK
  1. Correspondence to Dr Mark A Samaan, Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK; markasamaan{at}gmail.com

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Iron deficiency anaemia (IDA) presents the treating clinician with two issues: first, the need to establish a cause, and second, the need to correct the anaemia to improve symptoms and prevent complications. With a wide spectrum of severity, a host of potential causes ranging from benign to life-threatening, and multiple options for correction, one can expect significant variation in the management of IDA among clinicians.

It is within this context that Brookes et al take a macroscopic view of the trends in incidence and management of IDA in England between 2012 and 2018.1 A number of pertinent observations have been made. Overall, secondary care encounters for IDA increased, presumably due to increased recognition; there was a 68% increase in total hospital encounters for a primary diagnosis of IDA, encompassing a 58% increase in non-elective and 74% increase in day-case hospital encounters. The relative increase in day-case in comparison to non-elective management is important, given the significantly greater costs associated with the latter; while total annual day-case management costs in 2017/2018 (£46 million) were similar to total non-elective costs (£42.4 million), four times as many patients were managed as day-cases (n=1 03 806) compared with non-electively (n=25 275). However, there was noticeably wide variation among different health networks across England in rates of non-elective management, signifying a need for a unified approach.

Given the large cost discrepancy, an important question to answer is how best to manage patients in order to facilitate day-case management and prevent non-elective admissions. This should begin with ensuring early recognition of IDA. The association between deprivation and non-elective admissions suggests that lower socioeconomic status patients may be more likely to present at a later, more severe stage requiring admission. The …

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Footnotes

  • Contributors The article was drafted by RL and ES before being reviewed and edited by PMI and MAS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RL received educational grants from Ferring, Pfizer and Vifor Pharma. ES served as a speaker for Pharmacosmos. PMI served as a speaker, a consultant and/or an advisory board member for Abbvie, Warner Chilcott, Ferring, Falk Pharma, Takeda, MSD, Johnson and Johnson, Shire, Vifor Pharma, Pharmacosmos, Topivert, Genentech, Hospira, Samsung Bioepis, and has received research funding from MSD, Takeda and Pfizer. MAS served as a speaker, a consultant and/or an advisory board member for Sandoz, Janssen, Takeda, MSD, Falk and Samsung Bioepis.

  • Patient consent for publication Not required.

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