Editorial Iron-deficiency anaemia in the Emergency Room: a new opportunity for the use of intravenous iron Dan Morhaim1,2,3, Michael Auerbach4,5 Department of Emergency Medicine, Sinai Hospital, Baltimore, MD; 2Department of Health Policy and Management, Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 3Maryland House of Delegates, Annapolis, MD; 4Department of Medicine, Georgetown University, Washington, DC; 5Private Practice, Haematology and Oncology, Baltimore, MD, United States of America 1
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therapy, as a serious adverse event. Too often, it is then treated over-aggressively with antihistamines and pressors, transforming the minor infusion reaction into a haemodynamically significant serious adverse event. For example, diphenhydramine is often used as premedication, and can cause side effects such as somnolence, tachycardia, diaphoresis and hypotension, which, mistakenly attributed to the intravenous iron, leads to clinical confusion. It is only recently that admonitions to avoid diphenhydramine premedication have been published6,7. However, in patients with a history of multiple drug allergies or asthma, in whom there is a higher incidence of infusion reactions, premedication with corticosteroids may be of benefit8. The authors of the article in this issue of Blood Transfusion have previously reported on the use of intravenous iron for transfusion avoidance in common clinical settings. These include the peri-operative setting 9, after knee replacement 10, after total hip replacement11, and after colorectal surgery12. These are all examples of rational blood conservation and Patient Blood Management. In their current study, they establish the benefit of the formation of a fast-track anaemia centre within emergency departments, employing a collaborative approach with emphasis on early intervention with intravenous iron (ferric carboxymaltose in this case)1. Patients with moderate-to-severe anemia (
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therapy, as a serious adverse event. Too often, it is then treated over-aggressively with antihistamines and pressors, transforming the minor infusion reaction into a haemodynamically significant serious adverse event. For example, diphenhydramine is often used as premedication, and can cause side effects such as somnolence, tachycardia, diaphoresis and hypotension, which, mistakenly attributed to the intravenous iron, leads to clinical confusion. It is only recently that admonitions to avoid diphenhydramine premedication have been published6,7. However, in patients with a history of multiple drug allergies or asthma, in whom there is a higher incidence of infusion reactions, premedication with corticosteroids may be of benefit8. The authors of the article in this issue of Blood Transfusion have previously reported on the use of intravenous iron for transfusion avoidance in common clinical settings. These include the peri-operative setting 9, after knee replacement 10, after total hip replacement11, and after colorectal surgery12. These are all examples of rational blood conservation and Patient Blood Management. In their current study, they establish the benefit of the formation of a fast-track anaemia centre within emergency departments, employing a collaborative approach with emphasis on early intervention with intravenous iron (ferric carboxymaltose in this case)1. Patients with moderate-to-severe anemia (
