Authors (including presenting author) :
Yan CL(1), Young BR(2), Shek JWN(1), So PL(1)
Affiliation :
(1)Department of Obstetrics and Gynaecology, Tuen Mun Hospital, (2)WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
Introduction :
Blood transfusion is commonly used to treat severe anaemia due to heavy menstrual bleeding (HMB). However, it is associated with potentially serious morbidity. Furthermore, there has been a shortage of blood products despite an increasing demand in the past decade due to an aging population. Despite, intravenous iron therapy frequently used across multiple disciplines, its use for HMB has been inconsistent.
Objectives :
To investigate the safety and efficacy of ferric derisomaltose (FDI; Monofer®) and its clinical impact on blood transfusion requirements for women with severe anaemia from HMB.
Methodology :
This was a retrospective observational study of adult women admitted for HMB with haemoglobin level of < 8.0 g/dL and mean corpuscular volume of < 80 fL from 2014 to 2022. FDI was available as a treatment option for HMB in our hospital from 2018, and the study groups were defined by their admission date.
Result & Outcome :
In total, 1373 and 983 women were included in the study periods before and after the implementation of FDI. We observed a significant decrease (p< 0.001) in the mean number of blood units transfused per person from 2.02 (95% CI 1.96 - 2.07) units to 1.19 (95% CI 1.12 - 1.25) units across the two study periods. The difference remained after adjusting for confounders. We administered 384 doses of FDI and 14.3% experienced a hypersensitivity reaction (10.7% mild, 2.9% moderate, and 0.8% severe) at a mean onset time of 31.3 minutes. None required adrenaline administration. At three to four weeks after administration of FDI, both haemoglobin and ferritin levels increased significantly (p< 0.001) from a mean of 6.2 g/dL to 10.6 g/dL and from 22.5 μg/L to 149 μg/L, respectively.
In conclusion, intravenous FDI is a safe and effective alternative for women with severe anaemia due to HMB that mitigates blood transfusion requirements and helps to promote single-unit transfusion following Patient Blood Management principles.
