From the Guidelines
For an 82-year-old female with a hemoglobin level below 12 g/dL, I strongly recommend further evaluation and management to improve her quality of life and reduce the risk of morbidity and mortality. The patient's low hemoglobin level may be indicative of anemia, which is a common complication in elderly patients and can have significant consequences on their overall health and well-being 1. According to the ECCO-ESGAR guideline, anemia is defined as a hemoglobin level less than 13 g/dL for men and less than 12 g/dL for women, and it is essential to evaluate and manage anemia promptly to prevent adverse outcomes 1. The guideline also recommends evaluating the mean corpuscular volume (MCV) to determine the type of anemia, with microcytic anemia being the most common type in patients with inflammatory bowel disease (IBD) 1. Further testing, including serum ferritin, transferrin saturation, and vitamin B12 levels, may be necessary to determine the underlying cause of anemia and guide treatment decisions 1. I strongly recommend starting iron supplementation and/or vitamin B12 supplementation, depending on the underlying cause of anemia, to improve the patient's hemoglobin level and overall health outcomes. Additionally, dietary counseling and lifestyle modifications may be necessary to address any underlying nutritional deficiencies or other contributing factors to anemia. It is crucial to monitor the patient's response to treatment and adjust the management plan as needed to ensure optimal outcomes and minimize the risk of complications. In patients with IBD, it is also essential to monitor for signs of anemia and adjust treatment accordingly, as anemia can have a significant impact on quality of life and disease outcomes 1. Overall, prompt evaluation and management of anemia are critical to improving the patient's quality of life, reducing morbidity and mortality, and optimizing disease outcomes.
From the Research
Vitamin B12 Deficiency in the Elderly
- Vitamin B12 deficiency is common among the elderly, with an estimated 10%-15% of people over the age of 60 affected 2.
- The deficiency can be caused by inadequate intake, inadequate bioavailability, or malabsorption, and can affect individuals at all ages, but most particularly elderly individuals 3.
- The laboratory diagnosis of vitamin B12 deficiency is usually based on low serum vitamin B12 levels or elevated serum methylmalonic acid and homocysteine levels 2.
Diagnosis and Treatment
- Diagnosis of vitamin B12 deficiency is not straightforward, and setting a cut-off level to define serum vitamin B12 deficiency is difficult 4.
- Treatment and replacement with oral vitamin B12 can be as effective as parenteral administration, even in patients with pernicious anemia 4, 5.
- The suggested oral vitamin B12 dose is 1 mg daily for a month, and then a maintenance dose of 125 to 250 µg for patients with dietary insufficiency and 1 mg daily for those with pernicious anemia 4.
- Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severe neurologic symptoms 5.
Screening and Prevention
- Screening average-risk adults for vitamin B12 deficiency is not recommended, but screening may be warranted in patients with one or more risk factors, such as gastric or small intestine resections, inflammatory bowel disease, or use of certain medications 5.
- Patients older than 50 years and vegans or strict vegetarians should consume foods fortified with vitamin B12 or take vitamin B12 supplements to improve absorption rates 5.
- Patients who have had bariatric surgery should receive 1 mg of oral vitamin B12 per day indefinitely 5.