Introduction Iron deficiency anaemia (IDA) is a significant health problem accounting for over 70 000 annual hospital admissions in the UK (1). There is a drive to manage IDA earlier and more effectively, thereby improving quality of life and reducing hospital admissions. Intravenous (IV) iron has been shown to be better than oral iron in treating IDA related to inflammatory bowel disease (IBD) (2) as oral iron is often poorly tolerated. Although our institution uses Monofer (iron isomaltoside), there is a lack of real world data regarding its use in this patient group in the UK.

Aim: To review the aetiology of IDA, haemoglobin (Hb) outcomes and adverse events after Monofer in patients with and without IBD.

Method Patients with IDA who had received Monofer over 18 months were identified from the Barnet Hospital Day Unit attendance log. Data were collected via electronic records for patient demographics, pre and post infusion Hb, infusion frequency and infusion reactions.

Results Eighty-four patients with IDA received Monofer between January 2015 and July 2016. Nine patients (10.7%) suffered immediate infusion reactions. Of the remaining 75 IDA patients, 26 had IBD (15–UC; 11–Crohn’s disease; female=17; mean age=46 years) and 49 had non-IBD related conditions (19–idiopathic; 10–menorrhagia; 4–angiodysplasia; 16–other; female=41; mean age=62 years). Fifty-six patients (74.7%) received a single-dose; seven patients (9.3%) received two-doses; 12 patients (16%) received multiple-doses. The mean iron requirement per infusion was 957.7 mg in IBD patients and 987.2 mg in non-IBD patients. The mean pre-infusion Hb was 90.9 g/L in IBD and 88.0 g/L in non-IBD patients, with no difference in mean post-infusion Hb (IBD=116.4 g/L; non-IBD=117.9 g/L). The mean rise in Hb was 25.5 g/L (IBD) and 29.8 g/L (non-IBD).

Conclusion IV iron offers a rapid, efficient method of correcting IDA. ECCO guidelines recommend IV replacement as treatment of choice in IBD patients (3). We have shown that IBD patients respond to Monofer with a similar Hb rise to non-IBD patients. Although the response is rapid, we have concerns about infusion reactions in 10% of all recipients. We now advocate pre-infusion of chlorpheniramine to minimise adverse reactions.

References

1. . ”Hospital Episode Statistics”. Healthand Social Care Information Centre.

2. . Lee TW, et al. (2012).

3. . Dignass AU, et al. (2015).

Disclosure of Interest None Declared