Kashmir Gaddu
Introduction
While acute bleeding in haematuria is routinely managed, resultant iron deficiency anaemia (IDA) is chronically overlooked, despite national guidance mandating iron studies for anaemic surgical patients. With UK haematuria inpatient stays increasing to 10 days, failing to optimise IDA misses a critical opportunity to reduce transfusion burdens. This project aimed to evaluate and rectify IDA management in a tertiary urology centre.
Methods
A two-cycle closed-loop audit at a tertiary urology centre assessed adult haematuria admissions (Cycle 1: n=30; Cycle 2: n=21). Practice was benchmarked against the Centre for Perioperative Care and British Society for Haematology standards, aiming for ≥90% compliance in iron studies and management plans. Post-Cycle 1, a targeted clinical education intervention regarding iron protocols was delivered to junior doctors.
Results
Visible haematuria accounted for 100% of presentations, primarily driven by malignancy. Baseline anaemia prevalence was high (87% vs 76%). Initial assessment was deficient: only 17% had ferritin or transferrin saturation (TSAT) measured, and 7% received iron. Post-intervention, ferritin measurement doubled to 33%, TSAT recording reached 43%, and iron administration climbed to 33%. Despite process improvements, transfusion rates paradoxically increased (23% to 56%), and mean length of stay remained prolonged (6.5 vs 7.14 days).
Conclusions
Anaemia in haematuria represents a neglected clinical domain. While education doubled diagnostic screening, it proved inadequate for optimising outcomes or reducing transfusion reliance. Sustained improvement requires a paradigm shift from human-reliant education to automated forcing functions. Future cycles will implement mandatory electronic "Haematuria powerplans" at admission to systematically close this care gap.
Authors
King Hei Anthony Fong, Kashmir Gaddu, Waris Abdul Rashid, Rifat Hussain, Chaitya Desai
Midland Metropolitan University Hospital, Birmingham, United Kingdom