First-time red blood cell transfusions in the emergency department: A deficiency in micronutrient testing

To evaluate laboratory investigations for micronutrient deficiencies as the cause of anaemia prior to first-time red blood cell transfusions in the medical emergency department (ED) of a large academic hospital.

The ED is often the first point of contact for acutely ill anaemic patients, yet patient blood management principles are underutilised. Because micronutrient deficiencies are common, treatable causes of anaemia, they should be screened for to guide targeted treatment and reduce unnecessary transfusions.

We conducted a retrospective cross-sectional study of 198 adult patients receiving first-time transfusions in the medical emergency unit at Groote Schuur Hospital, South Africa, between April and October 2023. Laboratory investigations for iron, vitamin B12, and folate deficiencies were analysed and stratified by pre-transfusion mean corpuscular volume (MCV). Iron deficiency was evaluated using three locally used criteria. Data about haematinic supplementation were also collected.

Only 29% of patients received a full micronutrient deficiency workup, while 39% had no testing. Iron deficiency was the most frequent abnormality, and up to 30% of these patients had normocytic indices. Iron supplementation rates were high, but many patients without iron deficiency also received iron.

The ED encounter should be used as an opportunity to initiate basic micronutrient deficiency screening for anaemia, regardless of MCV.