Authors (including presenting author) :
Chan W(1), Tin WY(1), Tse PL(3), Yip SF(2), Lee AS(1), Lo SH (1), Wong CS(1)
Affiliation :
(1)Department of Clinical Oncology, Tuen Mun Hospital (2)Department of Medicine & Geriatrics, Tuen Mun Hospital (3)Department of Pharmacy, Tuen Mun Hospital
Introduction :
There has been few Patient Blood Management initiatives in clinical oncology. We introduced the pilot use of ferric carboxymaltose (FCM), a form of intravenous iron, in cancer patients to reduce blood transfusion. Prior to the addition of FCM to HA drug formulary in Oct 2019, FCM was available to our department as free samples.
Objectives :
(1)To reduce blood transfusion in cancer patients through rapid correction of iron deficiency anaemia by intravenous iron (2) To evaluate the safety profile of FCM including the risks of hypersensitivity reaction and hypophosphataemia
Methodology :
A protocol on the use of FCM in cancer patients was established in collaboration with haematologist and pharmacist. Eligible patients had to fulfil the following (1) moderate to severe iron deficiency anaemia(2) oral iron replacement not preferred either because rapid replacement needed or anticipated poor absorption of oral iron. Blood tests were taken at pre-specified interval to evaluate haemoglobin response, change of iron profile and phosphate level. Transfusion requirement before and after FCM was compared.
Result & Outcome :
36 patients were given FCM from Jan 2019 to Aug 2019. Mean baseline haemoglobin was 7.8g/dL. Among the 26 patients with haemoglobin trend available for analysis, the mean haemoglobin rise at 2 weeks and 4 weeks were 1.2g/dL and 2.1g/dL respectively. 88% of patients reported improvement of anaemic symptoms. Blood transfusion requirement in the 8-week period after FCM was reduced significantly compared with the 8-week period before FCM (p=0.016, pair t-test). No hypersensitivity reaction was reported. 23 patients had phosphate level available at baseline and repeated at 28 +/-4 days after FCM. There was a statistically significat reduction of mean serum phosphate level following FCM, from 1.04mmol/L at baseline to 0.75mmol/L at 28+/-4 days after FCM (p < 0.001, pair t-test). 4 patients (17%) had phosphate level less than 0.4mmol/L after FCM. No symptoms attributable to hypophosphataemia were reported. To our knowledge, this is the first protocol driven use of intravenous iron in clinical oncology in HA. We showed that intravenous iron was efficacious, safe and able to reduce blood transfusion in cancer patients. In view of the favourable pilot result, routine use of intravenous iron according to protocol was incorporated into our daily practice as a Patient Blood Management initiative. Our result may be useful for the promotion of Patient Blood Management and intravenous iron in other oncology centres.
