Iron deficiency anemia and anemia of chronic disease in geriatric hospitalized patients: How frequent are comorbidities as an additional explanation for the anemia?

Joosten, Etienne; Lioen, Pieter

doi:10.1111/ggi.12371

Cited by 32 publications

(30 citation statements)

References 23 publications

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“…25 Chronic blood loss, such as hematuria, and hemorrhoidal and gynecological blood loss, are mostly obvious causes associated with IDA. 27 Several non-invasive laboratory tests are available, and each test requires a thorough knowledge of its pros and cons before a proper interpretation of its contribution to the diagnosis of IDA is possible. 26 Diagnosis and epidemiology of IDA The diagnosis of IDA remains a challenge for the clinician.…”

Section: Symptoms and Clinical Presentationmentioning

confidence: 99%

“…23,28,29 Serum ferritin as an indicator for the assessment of iron stores is also widely available, well standardized and currently the most used parameter to diagnose IDA. 27 In recent years, a better understanding of the pathophysiology of the iron homeostasis has led to the introduction of newer laboratory analyses, such as serum transferrin receptor (sTfR), reticulocyte hemoglobin content or reticulocyte hemoglobin equivalent and serum hepcidin. [30][31][32] A broad range of ferritin thresholds up to 100 μg/L and even higher have been proposed in many older and recent studies depending on age, sex, patient selection and specific disease categories (i.e.…”

Section: Symptoms and Clinical Presentationmentioning

confidence: 99%

“…30,31,35 Indeed, many older patients with IDA and a serum ferritin level <20 μg/L have an elevated C-reactive protein level or erythrocytic sedimentation rate. 27 36 The sTfR has the potential advantage over serum ferritin that it lacks an acute phase component.…”

Section: Symptoms and Clinical Presentationmentioning

confidence: 99%

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Iron deficiency anemia in older adults: A review

Joosten

2017

Geriatrics Gerontology Int

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Anemia in older adults is a risk factor for numerous negative outcomes. There is no standard definition, but in most studies, anemia is defined as a hemoglobin value <12 g/dL for women and <13 g/dL for men. Absolute iron deficiency anemia is defined as the combination of anemia and the absence of total body iron. Serum ferritin is the most frequently used diagnostic parameter, but its concentration increases with age and in the presence of inflammatory diseases. Other laboratory tests, such as transferrin saturation, soluble transferrin receptor and the soluble transferrin receptor/ferritin index might provide useful information, but there is a wide variety in the cut-off values and interpretation of the results. Recent research regarding hepcidin as a central regulator of iron homeostasis is promising, but it has not been used yet for the routine diagnosis of iron deficiency anemia. In older iron deficiency anemia patients, an esophagogastroduodenoscopy and colonoscopy should be initiated in order to identify the underlying bleeding cause. CT colonography can replace a colonoscopy, and in specific cases, a video capsule is recommended. It remains crucial to keep in mind which potential benefits might be expected from these investigations in this vulnerable population, taking into account the comorbidity and life expectancy, and one should discuss in advance the possible therapeutic options and complications with the patient, a family member or a proxy. Oral iron administration is the standard treatment, but parenteral iron is a convenient and safe way to provide the total iron dose in one or a few sessions. Geriatr Gerontol Int 2018; 18: 373-379.

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Section: Symptoms and Clinical Presentationmentioning

confidence: 99%

Section: Symptoms and Clinical Presentationmentioning

confidence: 99%

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Iron deficiency anemia in older adults: A review

Joosten

2017

Geriatrics Gerontology Int

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“…In a recent study of 191 consecutive hospitalized elderly patients with anemia, 70% of the patients were found to have anemia related to inflammation. Sixteen percent of the patients with anemia of inflammation had concomitant chronic renal failure [4]. Of the patients with inflammatory anemia, 71% were suffering from an acute infection, 12% had cancer, and 16% had a chronic infection, such as a pressure ulcer, or a chronic autoimmune inflammatory disease.…”

Section: Epidemiologymentioning

confidence: 99%

“…Of the patients with inflammatory anemia, 71% were suffering from an acute infection, 12% had cancer, and 16% had a chronic infection, such as a pressure ulcer, or a chronic autoimmune inflammatory disease. [4]…”

Section: Epidemiologymentioning

confidence: 99%

Anemia of Inflammation

Fraenkel

2017

Medical Clinics of North America

163

105

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Impaired iron homeostasis and the suppressive effects of proinflammatory cytokines on erythropoiesis, together with alterations of the erythrocyte membrane that impair its survival, cause the anemia of inflammation. Recent epidemiologic studies have connected inflammatory anemia with critical illness, obesity, aging, and kidney failure, as well as with cancer, chronic infection, and autoimmune disease. The proinflammatory cytokine, interleukin-6, the iron regulatory hormone, hepcidin, and the iron exporter, ferroportin, interact to cause iron sequestration in the setting of inflammation. While severe anemia is associated with adverse outcomes in critical illness, experimental models suggest that iron sequestration is part of a natural defense against pathogens. In animal models and human patients, experimental therapeutic approaches targeting interleukin-6 or the ferroportin-hepcidin axis have shown efficacy in reversing anemia, although these agents have not yet been approved for the treatment of the anemia of inflammation.

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Anaemia in older people

Sanford

2022

Pathy's Principles and Practice of Geriatric Medicine

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Iron deficiency anemia and anemia of chronic disease in geriatric hospitalized patients: How frequent are comorbidities as an additional explanation for the anemia?

Abstract: Additional etiologies are often diagnosed in anemic older patients, but it remains unknown to what extent these diseases might influence the pathogenesis of the anemia. Individual and clinical judgment remain crucial to evaluating and treating older anemic patients.

Cited by 32 publications

References 23 publications

Iron deficiency anemia in older adults: A review

Iron deficiency anemia in older adults: A review

Anemia of Inflammation

Anaemia in older people

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