Original Article
Iron Deficiency Anemia—Bridging the Knowledge and Practice Gap

https://doi.org/10.1016/j.tmrv.2014.05.001Get rights and content

Abstract

Despite its high prevalence, anemia often does not receive proper clinical attention, and detection, evaluation, and management of iron deficiency anemia and iron-restricted erythropoiesis can possibly be an unmet medical need. A multidisciplinary panel of clinicians with expertise in anemia management convened and reviewed recent published data on prevalence, etiology, and health implications of anemia as well as current therapeutic options and available guidelines on management of anemia across various patient populations and made recommendations on the detection, diagnostic approach, and management of anemia. The available evidence confirms that the prevalence of anemia is high across all populations, especially in hospitalized patients. Anemia is associated with worse clinical outcomes including longer length of hospital stay, diminished quality of life, and increased risk of morbidity and mortality, and it is a modifiable risk factor of allogeneic blood transfusion with its own inherent risks. Iron deficiency is usually present in anemic patients. An algorithm for detection and management of anemia was discussed, which incorporated iron study (with primary emphasis on transferrin saturation), serum creatinine and glomerular filtration rate, and vitamin B12 and folic acid measurements. Management strategies included iron therapy (oral or intravenous), erythropoiesis-stimulating agents, and referral as needed.

Section snippets

Methods

The project was planned to feature a narrative overview of the evidence followed by unstructured discussions of an expert panel. For the purpose of the panel discussion and given its widespread acceptance, the World Health Organization (WHO) definition of anemia (Table 1) [11] was used unless otherwise indicated. The Panel was organized by the SABM (http://www.sabm.org), using a modified RAND Delphi method, as previously described [12]. In this method, candidates were selected based on their

Current Status of Anemia Across Populations

Summary of data on prevalence of anemia in various patient populations and the reported consequences of anemia is provided in Table 2. These data were reviewed and discussed by the panelists.

Significance of Anemia

The prevalence of anemia is high across all reviewed populations, especially in hospitalized patients, and emphasized anemia is associated with worse clinical outcomes including longer length of hospital stay, reduced survival, diminished quality of life, and increased risk of morbidity and mortality. Anemia is a modifiable risk factor of allogeneic blood transfusion with its own inherent risks. Anemia can also be a warning sign for underlying serious diseases (eg, colorectal cancer) [3].

Areas of Knowledge Gap

In reviewing the literature and the discussions, some areas in need for further research were noted. Despite the wealth of data on anemia and its significance in various populations, more studies are needed to better define its role in relation to confounders such as comorbidities and transfusion. The future studies should focus on assessing the impact of management of anemia and iron deficiency on improving clinical outcomes (as opposed to surrogate markers such as Hb level or transfusion

Conclusions

The evidence reviewed and discussed here supports the relatively high prevalence of anemia across many patient populations, especially in hospitalized patients. Anemia is associated with worse clinical outcomes including longer length of hospital stay, diminished quality of life, and increased risk of morbidity and mortality. Furthermore, anemia is a modifiable risk factor of allogeneic blood transfusion. Iron deficiency is usually present in anemic patients. An algorithm for detection and

Conflict of Interest

Aryeh Shander has been a consultant or speaker with honorarium for or received research support from Bayer, Luitpold, Masimo, Novartis, Novo Nordisk, OrthoBiotech, Pfizer, and Masimo & Zymogenetics. He is a founding member of SABM. Lawrence T. Goodnough has been a consultant for Eli Lilly, CSL Behring, Luitpold, AMAG, Amgen, and Centocorp/Biotech. Mazyar Javidroozi has been a consultant and contractor for SABM. Jeffrey Carson reported receiving grant support to his institution from Amgen as

Acknowledgment

Funding and support for this work was provided by the Society for the Advancement of Blood Management and AMAG Pharmaceuticals. The study sponsors had no role in study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit the manuscript for publication.

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