From the Guidelines
In an 82-year-old patient with leukopenia and mild iron deficiency anemia, the primary concern is to identify the underlying cause of leukopenia, as it can be due to various factors including chronic blood loss [ 1 ], infections, autoimmune disorders, bone marrow disorders, or side effects of medications.
Potential Causes of Leukopenia
- Chronic diseases: Such as gastrointestinal (GI) pathologies [ 1 ] which can lead to malabsorption of essential nutrients, including iron and other vital elements necessary for blood cell production.
- Medications: Certain drugs can suppress bone marrow activity, leading to leukopenia.
- Vitamin deficiencies: Deficiencies in vitamins like B12 or folate can affect blood cell production.
Management of Iron Deficiency Anemia
For the iron deficiency anemia, treatment with oral iron supplements is recommended, alongside dietary counseling to increase iron intake [ 1 ].
Approach to Leukopenia
The management of leukopenia will depend on its underlying cause. If medication-induced, discontinuing the offending drug may be necessary. In cases of autoimmune disorders or bone marrow failure, more specific treatments such as immunosuppressants or growth factor support (e.g., filgrastim) may be considered. Regular monitoring of the patient's complete blood count (CBC) and consultation with a hematologist are essential for guiding the diagnostic and therapeutic approach [ 1 ].
From the FDA Drug Label
Hematologic: Agranulocytosis, aplastic anemia, thrombocytopenia, leukopenia, neutropenia, hemolytic anemia, megaloblastic anemia, hypoprothrombinemia, methemoglobinemia, eosinophilia, thrombotic thrombocytopenic purpura, idiopathic thrombocytopenic purpura
The causes of leukopenia in an 82-year-old patient with mild iron deficiency anemia may include:
- Agranulocytosis or aplastic anemia
- Drug reactions, such as those caused by trimethoprim/sulfamethoxazole 2 2
- Folate deficiency, which may be exacerbated by trimethoprim/sulfamethoxazole 2 2
- Other blood dyscrasias, such as those listed in the adverse reactions section of the trimethoprim/sulfamethoxazole label 2 2 Note that the filgrastim label 3 does not provide information on the causes of leukopenia in this patient population.
From the Research
Causes of Leukopenia in an 82-year-old patient with mild iron deficiency anemia
- Leukopenia can be associated with iron deficiency anemia, as seen in approximately one third of patients with iron deficiency anemia 4
- Iron deficiency anemia is a microcytic, hypochromic anemia, and leukopenia may occur as a result of the underlying iron deficiency 4
- In some cases, iron deficiency may be the cause of leukopenia, as seen in a study where a patient's chronic idiopathic neutropenia was corrected after receiving oral iron supplements 5
- Leukopenia can also be a side effect of intravenous iron therapy, although its clinical significance appears to be limited 6
- The underlying cause of iron deficiency anemia should be investigated and treated, and oral iron therapy can be initiated to replenish iron stores 7
Possible Underlying Causes
- Iron deficiency anemia can be caused by various factors, including pregnancy, bleeding, and nutritional deficiencies 4, 8, 7
- In the elderly, anemia is a frequent finding, and hypochromic microcytic anemia, usually secondary to iron deficiency, is the most common type 8
- A careful search for the cause of the deficiency is necessary to provide effective treatment 8