Greater Glasgow and Clyde Medicines

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If haemoglobin (Hb) is low (anaemia), blood iron studies can identify if this is caused by iron deficiency. To ensure appropriate prescribing of iron, the following information on the diagnosis of IDA should be considered.

• Serum ferritin (SF) is the most useful test in confirming the diagnosis of iron deficiency.
• If Hb <130g/L in males or Hb <115g/L in females and SF <45micrograms/L this is diagnostic of IDA and no further iron studies are required.
• SF levels can be elevated by inflammatory processes and can mask iron deficiency.
• SF >150micrograms/L generally rules out IDA even in the presence of inflammatory disease and no further iron studies are required. If there is uncertainty, consider monitoring Hb in response to a trial of oral iron.
• Serum iron, transferrin (TF) and transferrin saturation (TSAT) are labile measurements and not reliable indicators of low iron stores, however they are useful for investigating high SF and possible iron overload.
• TSAT may be used in investigation of anaemia in heart failure, renal failure, elderly patients and those with inflammatory disease where SF is non-diagnostic (high transferrin or TSAT <16% can be suggestive of iron deficiency but should not be considered in isolation, refer to flowchart in full guideline).

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• The NHSGGC guideline on the Diagnosis and Treatment of Iron Deficiency Anaemia (IDA) in Adults has been updated. An abbreviated version of this guideline is available in the GGC Adult Therapeutics Handbook.
• There have been a number of changes to practice: ferritin ranges amended, guidance on iron studies, dosage advice, new IV iron product available, advice for IV iron during infection and prioritisation of single infusions where possible.
• Refer to important prescribing notes in the blog for a reminder of points to consider when prescribing oral and IV iron.

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• The NHSGGC Adult Therapeutics Handbook is a valuable resource designed to support NHSGGC healthcare professionals in the immediate management of a wide range of common acute medical conditions encountered in hospital practice. It features comprehensive chapters covering all major body systems, offering practical point-of-care guidance.
• The Introduction section contains a wealth of useful information for prescribers, including chapters on managing clozapine patients in acute hospitals, prescribing controlled drugs, prescribing unlicensed medicines and assessing medicines on admission.
• In addition to the chapters above, the Good Prescribing Practice for Inpatients chapter has recently been updated. It provides practical prescribing guidance for each stage of a patient’s acute hospital journey (see full blog).

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Do you use, write or review and approve NHSGGC clinical guidelines? 

If so, this blog contains key messages for safe, consistent and up-to-date practice.

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It is estimated that one in five general hospital beds in the UK are occupied by someone who has dementia, although this is likely an underestimate. Admission to hospital causes an increased risk of delirium developing, due to aspects such as infection, surgery, dehydration, as well as the disorientating and unfamiliar hospital environment. Refer to the Delirium: Medication Review in Acute blog for more details. All staff are likely to interact with someone who has dementia, and so should have the recommended skills and knowledge, as described in the Promoting Excellence Framework. Supporting modules for learning are available on Turas.

Patients with dementia may face challenges when communicating; staff may identify distress in people with dementia but not that pain is the underlying cause. This can lead to unrecognised, untreated or undertreated pain, which can cause further distress. Patients with dementia often receive less analgesia; a study has shown patients with dementia received one third of post-operative pain relief in comparison to their younger, non- cognitively impaired counterparts.

Effective pain assessment is fundamental in implementing effective pain management. Utilising a structured approach to identify and treat pain, and assess response to analgesia is imperative.

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