Anemia management: development of a rapidaccess anemia and intravenous iron service

Abstract

This article describes the initiation and evolution of the Rapid-Access Anemia Clinic (RAAC) at Guy’s and St Thomas’ Hospitals, London, UK. This clinic was set up to provide diagnosis and treatment, and to coordinate investigative procedures, where necessary, into the underlying causes of anemia. Initially piloted with anemic preoperative orthopedic patients, the clinic now treats a wide range of conditions, deriving from both internal and external referrals. Treatment includes dietary advice, supplementation with iron, vitamin B₁₂ and folate, and blood transfusion. Most patients at the RAAC need iron replacement, the majority of which require intravenous (IV) iron. Therefore the first-line IV iron-administration protocol is carefully considered to ensure viability of the service and patient satisfaction. Four IV irons available in the UK are discussed, with explanation of the benefits and drawbacks of each product and the reasoning behind the IV iron choice at different stages of the RAAC’s development. Costs to the service, affected by IV iron price and administration regimen, are considered, as well as the product’s contraindications. Finally, the authors reflect on the success of the RAAC and how it has improved patients’ quality-of-treatment experience, in addition to benefiting the hospital and National Health Service in achieving specific health-care mandates and directives. Drawing from the authors’ experiences, recommendations are given to assist others in setting up and providing a successful rapid-access anemia service or similar facility.

Keywords:

• hemoglobin
• iron deficiency
• ferric carboxymaltose
• iron sucrose
• iron dextran
• iron isomaltoside

Acknowledgments

The authors would like to acknowledge the staff who have helped make the RAAC the success it has become. Funding for editorial assistance and publication fees for this article were provided by Vifor Pharma Ltd. Vifor Pharma Ltd, had no input into the editorial content of the paper. Editorial assistance was provided by Aruna Jeans at Pope Woodhead and Associates Ltd.

Disclosure

Deepti Radia has received honoraria for participating on an advisory panel for Pharmacosmos. Claire Harrison has received unrestricted educational grants from Amgen and Roche. Ibrahim Momoh, Richard Dillon, Yvonne Francis, Laura Cameron, Toni-Lee Fagg, Hannah Overland, and Susan Robinson report no conflicts of interest in this work.