Deferoxamine injection practice assessment and common administration errors among adult thalassaemia patients
Abstract
Background: Thalassaemia is a hereditary blood disorder characterised by defective globin chains, which results in haemolysis and impaired erythropoiesis. Routine blood transfusion is required, which may lead to iron overload in a long run. Deferoxamine (DFO) provides effective iron chelation in thalassaemia patients, however, challenges were faced among patients, especially in ensuring proper drug administration techniques. Objective: The study aim is to describe the current DFO administration practice, common administration errors, patient compliance towards iron chelation therapy and to identify factors associated with serum ferritin levels. Methods: A cross-sectional study among adult thalassaemia patients was done from January 2019 until November 2020. Patients were assessed for DFO injection practices and compliances. A DFO score was used to assess steps of dilution and administration of DFO, categorised as good (score 75-100%), satisfactory (score 60-74%), and fail (score <60%). Compliance was assessed using a validated 7-questions survey; a score of less than 27 marks dictated non-compliance. A multivariate linear regression was used to identify factors associated with high serum ferritin level (>1000 µg/L). Results: Twenty-four patients were included in the study. For administration practice, 79.2% were able to administer independently. Abdomen was the most favoured injection site and most patients administered DFO at night. Although 75% of the patients had a good DFO score, DFO administration errors persist. The compliance rate was low (29.2%), and majority reported more than 4 times per month of missed doses. Working status (4664.13, 95% CI 1609.41-7718.86, p=0.005) and frequent missed dose (1152.39, 95% CI 382.18-1922.6, p=0.005) were identified as factors associated with serum ferritin level, controlling for other factors. Conclusion: DFO administration errors persist among thalassaemia patients. Patients who are working and non-compliant were identified to be associated with high serum ferritin level. Effective counselling method may be needed to properly educate patients on DFO administration and improve patients’ compliance.