Preoperative iron deficiency and anaemia increase the risk of both intra and post-operative morbidity. The condition is common, particularly in planned gynaecological and gastrointestinal disease surgery and in major joint replacement. Emergent treatment with blood products exposes the patient to infection and cross match risks and may delay surgery.
General practitioners are ideally placed to recognise the problem, since they are frequently involved in the diagnosis and early management of all these conditions. Detection of iron deficiency, with or without anaemia, is often the starting point for diagnosing the underlying pathology.
Perioperative blood transfusion is an inferior solution to timely iron replacement. With the advent of new forms of intravenous iron administration, general practices are also ideally placed to correct iron deficiency. Ferinject is available as a PBS listed item and has been listed for clinical use in Australia since 2013. Its key features are its relatively low toxicity and the fact that up to 1000 mg can be administered intravenously in as little as 15 minutes.
To encourage and facilitate practices with this new form of therapy, the National Patient Blood Management Collaborative was formed in April 2015 by the Australia Commission of Safety and Quality in Health Care. Lismore Base Hospital is part of the Collaborative. Working in conjunction with St Vincent's Private Hospital Lismore, it is striving to lower the need for perioperative transfusion.
Part of the strategy is to work in closer co-operation with North Coast GPs and specialists. The initial figures are encouraging showing that pre-operative iron administration is increasing in general practices on the North Coast with a corresponding decrease in hospital transfusions. Shorter hospital stays with fewer complications is welcomed by both patients and hospital administrators alike!
Iron Deficiency Management - Hospital or General Practice
Lismore Collaborative (HS5) showing increased
General Practice Management
Pathways for the management of both iron deficiency anaemia and Ferinject infusion are listed Mid and North Coast NSW HealthPathways website.
As part of the Collaborative, a training evening for General Practices has been organised for Wednesday 11 May. The night will be of interest to practices who have just set up, or are planning to set up, their own iron infusion service.
Those interested should register by contacting Beverly Hiles, the local Collaborative co-ordinator at
