From the Guidelines
Iron deficiency anemia in a 75-year-old patient requires immediate attention and a comprehensive diagnostic workup to identify underlying causes, particularly gastrointestinal bleeding, while initiating iron replacement therapy. The management of iron deficiency anemia (IDA) in adults, as outlined in the British Society of Gastroenterology guidelines 1, emphasizes the importance of investigating the underlying cause of IDA, especially in older adults where the risk of gastrointestinal malignancies is higher.
Key Considerations
- Approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the GI tract 1.
- Unexplained IDA in all at-risk individuals is an accepted indication for fast-track secondary care referral in the UK because GI malignancies can present in this way, often in the absence of specific symptoms 1.
- Bidirectional GI endoscopy is the standard diagnostic approach to examination of the upper and lower GI tract, though radiological scanning is an alternative in some situations for assessing the large bowel 1.
Treatment Approach
- Oral iron supplements such as ferrous sulfate 325 mg once or twice daily should be started, taken on an empty stomach with vitamin C to enhance absorption.
- If oral iron is not tolerated due to gastrointestinal side effects, alternative formulations like ferrous gluconate or iron polysaccharide may be tried, or switching to intravenous iron might be necessary.
- The treatment should continue for 3-6 months after hemoglobin normalizes to replenish iron stores.
Diagnostic Workup
- A thorough diagnostic workup is essential in elderly patients, including colonoscopy and upper endoscopy to rule out malignancy or other sources of blood loss.
- Additional causes to consider include nutritional deficiencies, medication effects, and chronic diseases.
- Regular monitoring of hemoglobin, ferritin, and transferrin saturation is important to assess treatment response 1.
Given the high prevalence of IDA and its potential to be a sign of underlying serious disease, particularly in older adults, a prompt and comprehensive approach to diagnosis and treatment is crucial to improve morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
Ferrlecit is indicated for the treatment of iron deficiency anemia in adult patients and in pediatric patients age 6 years and older with chronic kidney disease receiving hemodialysis who are receiving supplemental epoetin therapy.
The implications of iron deficiency anemia in a 75-year-old patient are not directly addressed in the provided drug labels.
- Key points:
- The labels discuss the treatment of iron deficiency anemia but do not provide information on the implications of the condition itself.
- The labels are focused on the administration and dosage of ferric gluconate for the treatment of iron deficiency anemia in specific patient populations 2, 2. The FDA drug label does not answer the question.
From the Research
Implications of Iron Deficiency Anemia in a 75-year-old Patient
The implications of iron deficiency anemia in a 75-year-old patient can be significant, with various potential causes and consequences. Some key points to consider include:
- Iron deficiency anemia is a common cause of morbidity and can arise as a consequence or complication from many diseases 3
- In elderly patients, iron deficiency remains the most common cause of anemia, and oral iron has been shown to be poorly tolerated, often ineffective, and frequently harmful 4
- Intravenous iron supplementation therapy has evolved to become a safe and effective treatment option for iron deficiency anemia, particularly in patients with intolerance or unresponsiveness to oral iron 5
- The use of intravenous iron has increased significantly in the last decade, but concerns remain about indications and administration, and a multidisciplinary team of experts has undertaken a consensus review to provide practical advice on managing iron deficiency in various clinical contexts 3
Diagnostic and Treatment Strategies
Some recommended diagnostic and treatment strategies for iron deficiency anemia in a 75-year-old patient include:
- Conducting serological celiac disease screening and performing bidirectional endoscopy (gastroscopy and colonoscopy) to investigate the cause of anemia 6
- Administering iron supplementation, with the goal of normalizing hemoglobin levels and replenishing iron stores, and considering intravenous iron therapy if oral treatment lacks efficacy or causes side effects 6, 3
- Selecting the appropriate iron therapy and evaluating treatment response to safely deliver improved outcomes through intravenous iron therapies 5
Potential Risks and Complications
Some potential risks and complications associated with intravenous iron supplementation therapy in a 75-year-old patient include:
- Severe infusion reactions, although the risk is comparable among all modern preparations and affects <1% of patients 5
- Hypophosphatemia, or the 6H syndrome, which can cause severe and potentially irreversible clinical complications such as bone pain, osteomalacia, and fractures 5
- Anaphylaxis, which is very rare but requires hospital administration of intravenous iron replacement therapy 7