(243) A standardized anemia protocol and obstetric clinic-based intravenous iron center reduces anemia at delivery admission

Protocols for diagnosis and management of antepartum anemia increase use of intravenous (IV) iron and improve pre-delivery hematocrit (Hct). IV Fe use is limited, however, by delays in diagnosis and administration restricted to infusion centers or inpatient units. To address these issues, we launched a standardized protocol for diagnosis and management of anemia across our practice as well as an IV iron center in our obstetrics clinic. We sought to study the impact of the protocol and onsite IV iron center on rates of IV iron administration and anemia diagnosis at the time of delivery.

Study Design:

Our retrospective cohort study included patients admitted for delivery at an urban academic hospital during a 10-month period pre- and post-intervention (3/2021-12/2021 and 8/2022-6/2023) that had a Hct recorded prenatally and at delivery hospitalization. Patients with a comorbidity contributing to anemia (hemoglobinopathy, bleeding disorder, renal disease, bleeding in pregnancy) were excluded. Anemia was defined as Hct < 33% at any point during pregnancy. The primary outcome was anemia on admission. Secondary outcomes were the receipt of IV iron and blood transfusion at delivery.

Results:

There were 2,704 and 2,624 patients in the pre- and post-intervention groups of which 765 (28.3%) and 998 (38.0%) had antepartum anemia (P< 0.001). Of patients with anemia, 47/765 (6.1%) and 162/998 (16.2%) received IV Fe pre- and post-intervention (P=0.001) with no significant change in the rate of PO Fe (24.5% vs. 27.5%, P=0.17). Anemia on admission was lower in the post-intervention group (34.7% vs. 39.5%, P=0.04) and persisted at a threshold of Hct < 30% (4.5% vs. 6.7%, P=0.05). The rate of transfusion also decreased during the study period (2.5% vs. 4.6%, P=0.02).

Conclusion:

The creation of an anemia protocol and obstetrics based IV iron center drastically increased utilization of IV Fe and decreased rates of anemia and blood transfusions at delivery at our institution. Given these findings, OB practices should strongly consider integrating similar interventions into their practices.