We read with much interest the editorial by Keshav and Stevens,1 which discusses a broad overview of the advancements in the knowledge of iron deficiency anaemia (IDA) with emphasis on management. We encourage GPs and community medicine to engage in the research on the condition, which remains one of the greatest burdens to global health.2 Their comments regarding implementation of parenteral iron therapy to manage IDA is of particular importance for a number of reasons.
The awareness of and education currently available to GPs for IDA does not reflect major advances in the aetiology and particularly the unrecognised impact on patient welfare. This has led to considerable under-management of IDA. For example, a large percentage (the average being 30%) of elective surgical patients, many of whom are pre-emptively referred by GPs, are in fact found to have IDA.3 Preoperative anaemia is independently associated with poorer outcomes.4 Recognising and managing preoperative anaemia is supported by authoritative bodies such as the Association of Anaesthetists of Great Britain and Ireland (AAGBI), NHS Blood and Transplant (NHSBT), and the National Institute for Health and Care Excellence (NICE).
However, it is not clear whether intravenous iron is the optimal treatment option in this setting. The Preoperative intravenous (IV) iron to treat anaemia in major abdominal surgery (PREVENTT)9 phase III randomised controlled trial addresses this question of whether intravenous iron can effectively treat anaemia and improve patient outcomes in the surgical patient.5 One issue is that screening data have revealed the difficulties and a major issue of patients being referred for operations not having simple blood tests such as a full blood count or electrolytes. In the referral to treatment, 18-week pathway, this is often overlooked to meet timelines.
We ask for the general practice community to join us and contribute to this research with the end goal to improve patient outcome. Our emphasis placed on education and awareness of IDA, ensuring patients are identified, with the inclusion of up-to-date blood tests prior to referral to tertiary hospitals. Engagement with general practice with time to pre-optimise patients, diagnose the cause of anaemia, and develop a patient blood management plan would be a substantial contribution to the improved management of this condition.
- © British Journal of General Practice 2017