What is the management for an 83-year-old patient with iron deficiency anemia?

Management of Iron Deficiency Anemia in an 83-Year-Old Patient

The management for this 83-year-old patient with iron deficiency anemia should include oral iron supplementation with ferrous sulfate 200 mg three times daily, along with a thorough gastrointestinal evaluation to identify the underlying cause of iron loss.

Diagnosis Confirmation

The laboratory values confirm iron deficiency anemia:

• Ferritin: 11 ng/mL (significantly below the diagnostic threshold of <30 ng/mL)
• Iron saturation: 19% (below the threshold of <20%)
• Total iron: 72 (low)
• Iron binding capacity: 389 (elevated)
• Hemoglobin: 11.6 g/dL (mild anemia)

Treatment Algorithm

1. Iron Replacement Therapy

• First-line treatment: Oral ferrous sulfate 200 mg three times daily 1

  • Alternatives: Ferrous gluconate or ferrous fumarate if ferrous sulfate is not tolerated
  • Liquid preparations may be considered if tablets are not tolerated
  • Consider adding ascorbic acid (vitamin C) to enhance iron absorption if response is poor 1, 2

• Expected response: Hemoglobin should rise by approximately 2 g/dL after 3-4 weeks 1

  • Monitor hemoglobin after 4 weeks to assess response 2
  • Complete iron studies (ferritin, transferrin saturation) should be checked 4-8 weeks after treatment 2

• Treatment duration: Continue treatment for 2-3 months after hemoglobin normalizes to fully replenish iron stores 2

2. Investigation of Underlying Cause

• Mandatory investigations for an 83-year-old with iron deficiency anemia:

  • Upper GI endoscopy with small bowel biopsy
  • Colonoscopy or barium enema 1

• These investigations are critical as the incidence of important pathology increases with age, particularly gastrointestinal malignancies 1

3. Alternative Treatment Options

• Parenteral iron therapy should be considered only if:
  • Patient demonstrates intolerance to at least two oral iron preparations
  • Non-compliance with oral therapy is an issue
  • Patient has conditions affecting absorption (e.g., inflammatory bowel disease, chronic kidney disease) 1, 2

Monitoring Parameters

• Target parameters:

  • Hemoglobin increase of 1-2 g/dL within 4-8 weeks
  • Ferritin ≥50 ng/mL (in absence of inflammation)
  • Transferrin saturation >20% 2

• Follow-up schedule:

  • Check hemoglobin after 4 weeks
  • Complete iron studies after 4-8 weeks of treatment
  • Resolution of anemia should be achieved by six months in 80% of patients 1

Important Considerations and Pitfalls

• Non-response to therapy may indicate:

  • Poor compliance
  • Misdiagnosis
  • Continued blood loss
  • Malabsorption 1

• Gastrointestinal side effects are common with oral iron:

  • Taking with meals may minimize nausea
  • May cause constipation or diarrhea 3
  • Consider alternate-day dosing if side effects are significant 4

• Appropriateness of investigation should be carefully considered in patients with severe co-morbidity, taking into account whether the results would influence management 1

• Contraindications for parenteral iron include:

  • Known hypersensitivity to IV iron preparations
  • Active systemic infection
  • Iron overload 2

• Warning: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. Keep out of reach of children 3

By following this management approach, the patient's iron deficiency anemia should resolve, and identification of the underlying cause will help prevent recurrence and potential complications.