Specialist Care

Avoiding Transfusions in Elective Surgery

For patients with severe anaemia or haemorrhage, blood transfusions have been shown to be life-saving. However, the default use of allogeneic blood transfusions for the treatment of anaemia may not be the optimal use of this valuable and limited resource.

Iron Deficiency in Secondary Care: Chronic Heart failure

Although many aspects of chronic heart failure (CHF) can be successfully managed, the prognosis for CHF patients typically remains poor. The challenging clinical outcomes in CHF emphasize the importance of identifying, and treating, modifiable co-morbid factors that independently accelerate the progression of CHF.

Iron Deficiency in Specialist Care: Gastroenterology

There are multiple gastrointestinal conditions and factors that lead to an increased risk of iron deficiency. Dietary iron absorption primarily occurs in the duodenum and upper jejunum, and so a dysfunction of these structures can result in malabsorption of iron and iron deficiency. In addition, the gastrointestinal tract is also a common site of chronic blood loss, which can deplete the body’s iron stores.

Iron Deficiency in Specialist Care: Nephrology

Iron deficiency is a common condition among patients with chronic kidney disease (CKD). A large-scale, epidemiological analysis suggests that the majority of patients with impaired renal function have low levels of iron, with approximately 58% of men and over 70% of women reaching the haematological definition of iron deficiency. Rather than being a feature of later stages of disease only, iron deficiency has been reported from as early as CKD stage 3.

Iron Deficiency in Specialist Care: Obstetrics and Gynaecology

Iron deficiency disproportionately affects women compared with men, and is particularly common in women of reproductive age. Iron deficiency is estimated to occur in approximately 9–11% of women aged 12–49 years in developed countries, with the rate dropping to 5% in women aged 50–69 years before increasing again in older women. Factors increasing the risk of iron deficiency in women include menstruation, pregnancy and peripartum blood loss.

Iron Deficiency in Specialist Care: Oncology

Iron deficiency is a frequent complication associated with cancer. In a single-centre study of 1,528 patients, more than 40% had iron deficiency, defined as a transferrin saturation [TSAT] level of ≤ 20%. Of these patients, 82% had functional iron deficiency (TSAT ≤ 20%, ferritin ≥ 30 ng/mL) and 18% had absolute iron deficiency (TSAT ≤ 20%, ferritin ≤ 30 ng/mL). Patients with pancreatic cancer, colorectal cancer and lung cancer showed the highest rates of iron deficiency.