OBJECTIVES: Almost 50% of anaemic cases are due to iron deficiency, in which guidelines recommend the administration of intravenous (IV) iron. Blood transfusions should be left for critical patients, as they provide faster haemoglobin (Hb) levels recovery, however they have also been associated with deleterious clinical outcomes. We aimed to characterize the clinical impact of blood transfusions in a population of hospitalised anaemic patients treated with IV iron.

METHODS: This was a retrospective cohort study. Patient records from a general Portuguese Hospital, with at least one inpatient administration of iron sucrose in 2014-2015, were reviewed. Adult anaemic patients with at least one Hb evaluation before and after the administration of IV iron were included. Endpoints assessed comprised Hb level (baseline and 8 weeks after), transfusions, length of stay (LOS) and inpatient mortality. Statistical analysis included generalized linear models, using a 5% significance level.

RESULTS: Data was collected for 878 patients (61.4% female; mean age (SD): 63.9 (20.6) years) and 945 IV iron administration episodes. Average baseline Hb level was 8.4 g/dl and increased to 10.3 g/dl at week 8. A total of 16.8% of patients corrected their anaemia by week 8. Blood transfusions were performed in 58.0% of the episodes. Having a blood transfusion was not significant for anaemia correction (OR: 0.9; 95% confidence interval [95%CI]: 0.5-1.7). Moreover, receiving blood transfusions was significantly associated with longer LOS (OR: 1.2; 95% CI: 1.1-1.3) and with a 2.6 fold increase in the risk of inpatient mortality (95%CI: 1.6-4.4), when controlled for age and sex.

CONCLUSIONS: Adding blood transfusion to IV iron therapy did not increase anaemia correction, but further deteriorated other patient health outcomes.