Reduction of Blood Transfusion in Iron Deficiency Anemia (ReBIDA): A Quality Improvement Initiative

Background: Iron deficiency anemia (IDA) is the most common form of pediatric anemia, with first-line treatment focusing on iron repletion through oral and/or intravenous iron. The American Society of Hematology (ASH)/the American Society of Pediatric Hematology and Oncology (ASPHO) Choosing Wisely Campaign recommends against packed red blood cell (PRBC) transfusion for asymptomatic IDA. PRBCs are a finite resource and carry treatment associated risk compared to iron therapies. The use of oral and intravenous iron is an effective, tolerated therapy modality for IDA which can be overlooked based on the degree of anemia. Study Design and Methods: Plan, Do, Study, Act methodology was used for this single institution quality improvement initiative. The objective was to decrease the percentage of PRBC transfusions in all admitted IDA patients from a baseline of 72% to a target of 50% by December 2022 and to sustain for 12 months. Interventions consisted of multidisciplinary, evidence-based didactic education sessions and development of a single institution clinical practice guideline for the treatment of IDA. Results: In the pre-education/baseline group, 72% (n = 57/79) of patients received PRBC transfusion for the treatment of IDA, compared to the posteducation/intervention group where 38% (n = 29/76) of patients received PRBC transfusion for the treatment of IDA (p value < 0.0001). In the pre-education/baseline group, 19% (n = 11/57) of patients received PRBC transfusions not indicated based on the developed CPG, compared to 6.9% (n = 2/18) in the posteducation/intervention group (p value = 0.20). Discussion: This work demonstrates how multidisciplinary, education- and evidence-based interventions lead to clinically and statistically significant reductions in PRBC transfusion for admitted patients with IDA.