Small Bowel, Nutrition and Miscellaneous Poster Awards 2021 - Second Prize

Dr Rachel Varley
South Tipperary General Hospital

TBA (21W172)

Quality Improvement Initiative for Iron Deficient and Restrictive Anaemia Management In The Frail Older Person


R Varley, I Pillay


Department of Gastroenterology, Tipperary University Hospital, Clonmel, Co Tipperary Department of Geriatric Medicine, Tipperary University Hospital, Clonmel, Co Tipperary


A previous study in this centre showed low rates of classification and correction (21%) of IDA in the frail older person. Non-invasive investigation to outrule coeliac disease and correction of IDA should be standard practice for all patients regardless of frailty.


To improve the classification and correction of IDA in the frail older person.


We modified an inter-disciplinary Comprehensive Geriatric Assessment (CGA) to include haemoglobin, MCV, Iron studies and coeliac screening. A prospective study was conducted over a 9-week period from July 2021 to September 2021. Clinical and biochemical data was retrieved from patient notes and the electronic record of patients undergoing CGA. Data was entered to an anonymised database and analysed using descriptive statistics.


73 patients were included. The median age was 84(69-96) years. 60% were female (n=44). Median Clinical Frailty Score (CFS) was 6 (±1). 40 (53%) patients had anaemia with a median Hb of 10.6 (7.0-12.6). The median age was 85(69-95) years, 29 (62%) were female and median CFS was 7(±1.00712) 27 patients had evidence of Iron deficiency anaemia (N=9) or iron restricted anaemia(IRA). Three patients had concomitant folate and B12 deficiency. Coeliac screen was completed in 13 patients (48% vs 22.7% in prior study). Iron was replaced in all 22 reviewed patients (100% vs 21.3%)


Modification of an inter-disciplinary CGA resulted in a five-fold improvement in the correction of IDA and two-fold improvement of coeliac screening. Implementation of an algorithm to allow an inter-disciplinary team to request coeliac antibodies will be developed to standardise practice.

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