AN AUTOMATED ELECTRONIC MEDICAL RECORDING SYSTEM FOR MONITORING TRANSFUSIONAL IRON OVERLOAD

Abstract

Frequent blood transfusion to treat chronic hematopoietic dysfunctions, such as aplastic anemia and myelodysplastic syndrome, causes iron overload and leads to failure of various organs in patients with anemia. After administration of Deferasirox, an oral iron-chelating agent, as part of iron chelation therapy, increased evidence of the efficacy of iron chelation therapy in treating transfusional iron overload has been reported. The medical guideline for transfusional iron overload in Japan was announced in July 2008, indicating diagnostic criteria for transfusional iron overload and criteria for iron chelation therapy. To assess the implementation of iron chelation therapy, we examined actual data on transfusional iron overload during a five-year period from January 2007 to December 2011 at Saga University Hospital. A total of 419 patients who received over 20 units of annual total erythrocyte transfusion were analyzed. Fifteen people received chelation therapy with Deferasirox during the study period, but only four had chelation therapy initiated in accordance with the medical guide for transfusional iron overload, likely due to both a difficulty in understanding precisely the total units of erythrocyte transfusion in a patient and delayed recognition of iron overload status. Taking these findings into account, we established a new system of electronic medical recording in our hospital. The program consists of three phases: calculation of total units of erythrocyte transfusion in a patient, automatic ordering of a ferritin test, and displaying the results of serum ferritin level to the attending physician. We describe here this integrated program for managing transfusional iron overload based on an electronic medical record system.