From the Guidelines
I would not recommend dietary iron increase or ferrous supplements for an 84-year-old man with low iron levels without first determining the underlying cause. Low ferritin levels in an elderly man should prompt investigation for potential gastrointestinal blood loss, particularly colorectal cancer or other serious conditions 1. Iron supplementation might temporarily improve lab values but could mask ongoing bleeding or other pathology. The appropriate approach is to refer this patient for medical evaluation, which would likely include a complete blood count, iron studies, and possibly endoscopic procedures to identify the source of iron deficiency.
Key Considerations
- Once the cause is identified and addressed, the physician may prescribe an appropriate iron supplementation regimen, typically ferrous sulfate 325mg once or twice daily, taken with vitamin C to enhance absorption and between meals to maximize effectiveness 1.
- Side effects like constipation, nausea, and black stools should be monitored.
- For elderly patients, starting with a lower dose and gradually increasing may improve tolerance.
- Intravenous iron may be considered if the patient cannot tolerate oral iron or if blood counts or iron stores do not improve with oral iron supplementation 1.
Treatment Approach
- The fundamental principle here is that iron deficiency is a symptom requiring diagnosis before treatment, especially in older men where serious underlying conditions must be ruled out.
- A recent study suggests that taking iron with 80 mg ascorbic acid on an empty stomach improves iron absorption, but evidence supporting vitamin C administration to improve iron absorption is mixed 1.
- Tea and coffee are powerful inhibitors of iron absorption and should not be consumed within an hour after taking iron 1.
From the FDA Drug Label
CONTAINS: Each tablet contains 324 mg of ferrous sulfate, equivalent to 65 mg of elemental iron, providing 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older. The FDA drug label does not answer the question.
From the Research
Iron Supplementation for an 84-year-old Man
- The patient has low iron levels (hypoferritinemia) with an iron panel result of 41.
- Considering the patient's age and iron deficiency, it is essential to choose an appropriate iron supplementation method.
Dietary Iron Increase vs. Ferrous Supplements
- Increasing dietary iron may not be sufficient to address the patient's iron deficiency, especially if the deficiency is severe 2.
- Ferrous supplements, such as ferrous sulfate, are commonly used to treat iron deficiency anemia, but they can cause gastrointestinal side effects 3, 4.
Types of Iron Supplements
- Ferrous sulfate is a commonly used iron supplement, but it may not be the best option for this patient due to potential gastrointestinal side effects 3, 4.
- Lactoferrin supplementation has been shown to have better effects on serum iron and hemoglobin levels compared to ferrous sulfate, with fewer side effects 3.
- Other iron supplements, such as bis-glycino iron II, may be better tolerated than ferrous sulfate 4.
Guidelines for Iron Supplementation
- The American Journal of Clinical Nutrition guidelines recommend oral iron supplementation as the preferred route, especially in children and women in the pre- or postpregnancy period 2.
- Intravenous iron supplementation may be necessary in certain situations, such as chronic kidney disease or chemotherapy-induced anemia 2.
Considerations for this Patient
- The patient's age and iron deficiency level should be taken into account when choosing an iron supplementation method.
- The potential for gastrointestinal side effects and the patient's ability to tolerate the supplement should also be considered 3, 4.
- Lactoferrin supplementation may be a suitable option for this patient, given its better effects on serum iron and hemoglobin levels and fewer side effects compared to ferrous sulfate 3.