Iron Status Interpretation in an Elderly Male
Yes, these values indicate iron deficiency in this elderly male patient, and gastrointestinal investigation should be strongly considered to identify the underlying cause. 1
Iron Parameter Analysis
Your patient's iron studies demonstrate clear iron deficiency:
Ferritin 27 ng/mL: This is below the 30 μg/L threshold that indicates depleted iron stores, even in the absence of inflammation 1. In elderly patients without active inflammation, ferritin <30 μg/L is diagnostic of iron deficiency 1. The British Society of Gastroenterology confirms that ferritin <15 μg/L is highly specific (specificity 0.99) for iron deficiency, and values up to 45 μg/L warrant investigation 1.
Transferrin Saturation 24%: While technically above the traditional 20% cutoff used in some contexts, this borderline value combined with low ferritin confirms inadequate iron availability for erythropoiesis 1. In healthy subjects, absolute iron deficiency is defined by TSAT <16% and ferritin <12 ng/mL, but your patient's ferritin of 27 clearly indicates depleted stores 1.
TIBC 270 mg/dL: This is within normal range (typically 250-370 mg/dL), which is consistent with iron deficiency without significant inflammation 1.
Serum Iron 65 mcg/dL: This is on the low side of normal (typically 60-170 mcg/dL for males), further supporting iron deficiency 2.
Clinical Significance in the Elderly
Iron deficiency in elderly males is uncommon and warrants thorough investigation for gastrointestinal pathology, particularly malignancy. 1 Unlike premenopausal women where menstrual losses are common, elderly males lack physiologic blood loss mechanisms, making pathologic causes more likely 1.
Key Considerations:
High yield of pathology: When iron deficiency is confirmed in elderly males, gastrointestinal investigation reveals significant pathology in a substantial proportion of cases 1.
Ferritin interpretation: The ferritin of 27 ng/mL is unequivocally low, even accounting for the fact that ferritin can be falsely elevated by inflammation (as an acute phase reactant) 1. A ferritin >100 μg/L would be needed to confidently exclude iron deficiency in the presence of inflammation 1.
Multiple potential causes: Iron deficiency in the elderly is often multifactorial, including occult blood loss, medications (NSAIDs, aspirin, anticoagulants), reduced absorption, poor diet, and chronic kidney disease 1, 3.
Recommended Diagnostic Approach
Both upper and lower gastrointestinal tract evaluation should be performed unless there are contraindications due to comorbidities or limited life expectancy: 1
Upper endoscopy with duodenal biopsies: This reveals pathology in 30-50% of patients with iron deficiency anemia and can identify celiac disease (present in 2-3% of cases) 1. Small bowel biopsies should be obtained even if the mucosa appears normal 1.
Colonoscopy or CT colonography: Essential as dual pathology (lesions in both upper and lower GI tracts) occurs in approximately 10% of cases 1. In elderly patients with significant comorbidities, CT colonography may be a safer alternative to colonoscopy 1.
Celiac serology: Anti-endomysial or anti-tissue transglutaminase antibodies should be checked, as celiac disease can present with isolated iron deficiency 1.
Common Pitfalls to Avoid
Don't assume dietary insufficiency: While borderline iron-deficient diets are common, this should not preclude full investigation in elderly males 1.
Don't be falsely reassured by normal TIBC: The TIBC of 270 simply indicates absence of significant inflammation; it doesn't exclude iron deficiency 1.
Don't delay investigation for medication history: Use of aspirin, NSAIDs, or anticoagulants should be documented but should not deter investigation 1.
Don't overlook non-anemic iron deficiency: Even if hemoglobin were normal, a ferritin of 27 ng/mL warrants investigation in an elderly male given the high likelihood of underlying pathology 1, 4.
Risk Stratification
The risks and benefits of invasive investigation should be carefully weighed in patients with major comorbidities, significant frailty, or limited performance status. 1 However, for most elderly males with confirmed iron deficiency, the potential to identify treatable malignancy or other significant pathology justifies investigation 1.
The combination of low ferritin (27 ng/mL), borderline transferrin saturation (24%), and male gender in an elderly patient creates a clinical scenario where gastrointestinal malignancy must be excluded 1.