Iron deficiency anemia in older adults: A review

Abstract

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.

Anemia management in non-menopausal women in a primary care setting: a prospective evaluation of clinical practice

“…At the opposite, an iron overload increases the output of Hepcidin. Therefore a daily administration of 15 mg and 50 mg of elementary iron proved to be as effective as one dose of 150 mg for elderly patients presenting ID [28,29]. In our study, only one iron supplementation prescription was inferior to 60 mg. That is not surprising, considering that the recent findings were not included in the few existing official guidelines.…”

Geri̇atri̇ Kli̇ni̇ği̇mi̇zde Yapilan Kemi̇k İli̇ği̇ Bi̇yopsi̇ Sonuçlarinin Çok Yönlü Değerlendi̇ri̇lmesi̇: Tani, Prezentasyon Ve Mortali̇te

“…Hastalarda herhangi bir ön tanı ile yapılan biyopsilerde, normal kemik iliği sonucunun %48.7 olduğu görülmektedir. Bunlar arasında tanısı diğer klinik tablolar ile iç içe geçmiş demir eksikliği, [20] vitamin B12 eksikliği [21] gibi nutrisyonel eksiklikler bulunmaktadır. Yine normal popülasyonda olduğu gibi, yaşlılarda kemik iliği infiltrasyonu olmaksızın enfeksiyon hastalıklarının, [22] ilaç etkilerinin [23] geçici hematolojik değişiklikler yapabileceği göz önüne alınmalıdır.…”

Iron-Deficiency Anemia

“…Depending on the underlying condition that caused the iron deficiency, the patients may present different symptoms and signs such as abdominal pain, urinary and genital symptoms, and respiratory disorders. The most frequent conditions associated with iron deficiency are gastric and duodenal ulcers; hiatal hernia; digestive carcinomas; and surgical interventions such as gastrectomy, intestinal resections, or urogenital pathology, for example, uterine fibroid, genital cancer in women, and kidney diseases that cause hematuria [46][47][48]. Table 3.…”