Anemia

Literature:

ACOG PB 233 Anemia in Pregnancy (Aug 2021) 

Other useful links:

Dalby presentation on Iron Infusions from 10/24/2019 

Iron Deficit Calculator 

Osmosis video Anemia in Pregnancy 

Meriter Info:

Scheduling Iron infusions:

For Meriter: 

Clinician should call OB triage (608-417-6228) and provide the following information:

• Patient name

• Infusion Start date

• Number of appointments needed

• Appointment frequency

• Make a note that these should not be scheduled on Wednesday if at all possible

Instructions for the patient: Provide the patient the OB Triage phone number (608-417-6228) and instruct them to call OB triage to schedule appointments at their convenience

Triage has developed a process to hold the information provided by the clinic to reference when the patient calls. The HUC will schedule the appointments once the patient calls.

Ordering Iron infusions:

For residents at Meriter:

Preferred Iron formulations:

1st line - iron dextran 25 mg test dose followed by 975 mg full dose x1

2nd line - ferumoxytol 1020 mg x1

Last line - iron sucrose 300 mg x3

There is also currently a national shortage of iron sucrose which gives even more reason to reserve it only for cases of allergy/intolerance to both of the other two preferred agents

You can see future scheduled iron infusions in the snapboard, if you have time you can place the orders for the infusion ahead of time as you would for an induction

1. See preferred formulations above

2. Enter order set for iron infusion

3. Generally do not need to order premeds but place as PRN orders (consider methylprednisone if pt has hx of asthma, multiple drug allergies, or inflammatory arthritis)

4. Monitor for anaphylactic reaction (flushing/anxiety) for 1 hour

5. Discharge to home 

St Mary's Info:

Scheduling Iron infusions:

Two different location options for scheduling iron infusions through SSM: 

St Mary's Hospital Short Stay Unit or St Mary's Infusion Center (doesn't work as well) 

Inconveniently, both have VERY different workflows and have different formulations available for IV iron.  

Notably, St Mary's OB triage is NOT seeing patients for scheduled iron infusions 

Ordering Iron infusions:

Dotphrases in the UW chart with workflow information for ordering iron infusions through Short Stay versus Infusion Center (Look under Bruehlman/Carlson/Dalby). 

".IVIRONSSMSHORTSTAY"  - Summary below:

Have Team RN call St. Mary's Short Stay - 608-258-6856

They will offer dates/times for infusion and create an encounter in St. Mary's Epic.

Once created, provider will place orders for:

Admit To:  Short Stay, needs that day's inpatient St. Mary's attending

IV - Place and Maintain

Iron Infusion Order

Epi PRN

SoluMedrol PRN

".IVIRONSSMINFUSIONCENTER" (if you want to try)

Notably, the infusion center option puts a lot less burden on our RNs regarding logistics and scheduling, however it doesn't seem to work well!  Also, providers using the infusion center option must log into the SSM chart on at least two separate occasions to finalize iron infusion plans through the infusion center.

Can use the dosing from Meriter as well as formulation preference