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P480. Fast, safe and effective treatment of iron deficiency (ID) of different aetiologies using iron isomaltoside 1000 - experience from clinical practice

L. Craven1, J. Snook1, S. Surgenor1, U. Bapat2, C. Strom3, E. Williams1, 1Poole Hospital NHS Foundation Trust, Gastroenterology, Poole, United Kingdom, 2Pharmacosmos UK Ltd, Pharmacosmos UK, Thame, United Kingdom, 3Pharmacosmos, Medical Affairs, Holbaek, Denmark

Background

Parenteral iron has been used increasingly over the last decade to treat specific patient groups with ID anaemia. However, there is limited evidence of safety and efficacy across all patients with ID, particularly those with underlying malignancy or inflammation.

Methods

Data was analysed from all outpatients receiving iv iron isomaltoside for confirmed ID at our UK District Hospital between 1st April and 31st December 2012, regardless of underlying diagnosis or comorbidity. Patients received infusions on a 7-day nurse led unit run by the Gastroenterology Unit located within the main hospital.

ID was defined by ferritin <24 µg/l, transferrin saturation index (TSAT) <15% or a blood film compatible with ID. Anaemia as a low haemoglobin concentration (Hb) (men <130 g/l, women <115 g/l). Patients were assessed for their first treatment within the study period only, albeit 1 or 2 infusions. The dose of parenteral iron was at the discretion of the referring Consultant.

All patient had post infusion bloods, 75 (88%) within 4 weeks. Data on the cause of ID and significant comorbidity was collected.

Results

85 patients had confirmed ID with 80 of these having ID anaemia. Referrals were from a range of medical, surgical and oncological specialities, age 18–92 years (median 73 years), 55 (65%) were female. Baseline bloods [median and interquartile range (IQR)] were Hb 90 g/l (80–99), Mean Cell Volume 81fL (72–88), Mean Cell Haemoglobin 24.8 pg (22.2–28.0), ferritin 15 µg/l (9–24) and TSAT 9% (5–15).

Most patients had extensive comorbidity; 29 (34%) had active malignancy and 44 (77%) of those without malignancy had active inflammation. The median iron dose was 14.6 mg/kg (IQR 11.2–17.5).

No significant adverse reactions occurred and all patients received the full infusion.

Post infusion bloods demonstrated a median increase in Hb of 2.3 g (Figure 1) with 52% of patients having a Hb increase of >20 g/l.

The Hb rise was significantly higher in individuals with a lower baseline Hb p < 0.0001 (Figure 2).

Figure 1. Change in baseline haemoglobin following iron isomaltoside infusion.

Figure 2. Change in haemoglobin plotted against baseline haemoglobin.

Conclusion

Treatment with parenteral iron is safe and effective in all patients including those with cancer or active inflammation. A rapid rise in Hb within 4 weeks is seen in many patients particularly when the baseline Hb is low.