The mineral iron , found in a variety of foods, is important for good health. Though senior citizens elderly generally consume enough iron in their diet to meet the Recommended Dietary Allowances for iron, there are other factors that may contribute to iron deficiency anemia in this population. Every person needs iron throughout the stages of our lives to make hemoglobin, a protein that carries oxygen to tissues in the body. Iron also plays a role as a part of other proteins within the body. Though we store some iron in our body, a low dietary iron intake over time can lead to iron deficiency anemia.
It is indeed common for doctors to check for bleeding or some Older person taking iron of abnormality in the colon. My haemogolobin was 5. The Mayo Clinic has a good article on bruising in late life here: Easy bruising: Why does it happen. Indeed, in a recent retrospective study, hepcidin levels were proven Horny odc hub in identifying IDA patients who did not respond to oral iron supplementation Bregman et al. Stewart R.
Public loo fuck. Factors that Increase the Risk of Iron Deficiency Anemia with Age
We do this because the size of the red blood cells can help point doctors towards the underlying cause of anemia. It should also be possible to check her blood pressure at least every few days in the beginning, to make sure she is not too high or too low with the current dose of BP meds. Hi, I appreciate your posted info on low hemoglobin. This is eprson follow-up query on the case referred by Ms. Her HGB level was 7. I should mention he is in palliative care currently. I Mmf outdoor submission been told to ring back in a few days. Please see this comment and the article below, regarding iron deficiency anemia when endoscopy is negative. In terms of what can be done iro Older person taking iron residence, it depends on whether the doctor can come see him at his facility, to ask more questions about his symptoms and to examine him. Best Value! Slept Older person taking iron hrs instead of Indications approved by the U. Please post them below! Iron is at 55, no previous to compare, B is atFolic acid is above 20, actual number not given, feritin at
Iron deficiency ID is relatively common among the elderly population, contributing substantially to the high prevalence of anemia observed in the last decades of life, which in turn has important implications both on quality of life and on survival.
- The mineral iron , found in a variety of foods, is important for good health.
- Have you ever been told that an older relative has anemia?
- All of your cells contain some iron, but most of the iron in your body is in your red blood cells.
Have you ever been told that an older relative has anemia? And anemia becomes even more common as people get older. Misunderstanding anemia can also lead to unnecessary worrying, or perhaps even inappropriate treatment with iron supplements.
For more information on the CBC test, see this Medline page. By convention, to detect anemia clinicians rely on the hemoglobin level and the hematocrit, rather than on the red blood cell count. However, different laboratories may define the normal range slightly differently. A hemoglobin level below normal can be used to detect anemia.
Clinicians often confirm the lower hemoglobin level by repeating the CBC test. If clinicians detect anemia, they usually will review the mean corpuscular volume measurement included in the CBC to see if the red cells are smaller or bigger than normal.
We do this because the size of the red blood cells can help point doctors towards the underlying cause of anemia. The red blood cells in your blood use hemoglobin to carry oxygen from your lungs to every cell in your body. This second factor is very important to keep in mind. Compared to most cells in the body, normal red blood cells have a short lifespan: about days. So a healthy body must always be producing red blood cells.
This is done in the bone marrow and takes about seven days, then the new red blood cells work in the blood for months. Once the red blood cell dies, the body recovers the iron and reuses it to create new red blood cells.
Anemia happens when something goes wrong with these normal processes. In kids and younger adults, there is usually one cause for anemia. Problems producing red blood cells. These includes problems related to the bone marrow where red blood cells are made and deficiencies in vitamins and other substances used to make red blood cells. Common specific causes include:. Problems losing red blood cells. Blood loss causes anemia because red blood cells are leaving the blood stream.
This can happen quickly and obviously, but also can happen slowly and subtly. Slow bleeds can worsen anemia by causing an iron-deficiency, as noted above. Some examples of how people lose blood include:. There is also a third category of anemias, related to red blood cells being abnormally destroyed in the body before they live their usual lifespan. Understanding the timeline of the anemia — did it come on quickly or slowly?
Is the red blood count stable or still trending down with time? If the anemia is bad enough, or if the person is suffering significant symptoms, doctors might also consider a blood transfusion. This issue especially comes up when people are hospitalized or acutely ill. If you are told that you or your older relative has anemia, be sure you understand how severe it seems to be, and what the doctors think might be causing it.
This will help you understand the plan for follow-up and treatment. Be sure to request and keep copies of your lab results. It will help you and your doctors in the future to be able to review your past labs related to anemia and any related testing. A very common diagnosis in older adults is iron-deficiency anemia. If you are diagnosed with this type of anemia, be sure the doctors have checked a ferritin level or otherwise confirmed you are low on iron.
I have actually reviewed medical charts in which a patient was prescribed iron for anemia, but no actual low iron level was documented. This suggests that the clinician may have presumed the anemia was due to low iron. If an iron deficiency is confirmed, be sure the doctors have tried to check for any causes of slow blood loss. It is common for older adults to develop microscopic bleeds in their stomach or colon, especially if they take a daily aspirin or a non-steroidal anti-inflammatory drug NSAIDs such as ibuprofen.
Bear in mind that iron supplements are often quite constipating for older adults. So you only want to take them if an iron-deficiency anemia has been confirmed, and you want to make sure any causes of ongoing blood loss which causes iron loss have been addressed.
If you are diagnosed with anemia or if you notice a lower than normal hemoglobin on your lab report, be sure to ask questions to understand your anemia. If you are diagnosed with low iron levels: could it be from a small internal bleed and could that be associated with aspirin, a non-steroidal anti-inflammatory medication such as ibuprofen, or another medication? Do you have questions about anemia in older adults? Please post them below! Note: We have reached over comments on this post, so comments will now be closed.
Thank you! The best thing I did this year was sign up for your site. I question all medical treatments and drugs. I am eighty six years old and in excellent health. Your information is so intelligent and complete on every subject you cover, I am impressed..
Do I sound like a Fan? Yes I am. Thank you for all you do. Good Morning my mother was told that her hemoglobin is 9. She has always delt with anemia but her hemoglobin has never been this low. Could the chemo be a cause of her hemoglobin being so low? She is also on blood thinners for an irregular heartbeat has has been fixed but she is still on the blood thinner. She is currently taking iron infusions. I am hoping that all of this has caused her iron levels to get worse and not something else more serious.
I would like your opinion. A ferritin of 6 sounds quite low and concerning for iron-deficiency. I would recommend that you ask her doctors to explain what they think is causing her anemia. Good luck! My mother is 61 years of age and her haemoglobin has fell from She is hypothyroid since a long time and it is controlled.
She has a mild gastroenteritis and always suffers from constipation. She got a little cold since a few days. What could be the cause of her low haemoglobin?.
Also to mention her mch and mcv values are normal while hct is low. I have listed the common causes of anemia and hemoglobin drops in the article. I would recommend you ask her health providers to explain what they think are the most likely possibilities.
You may also want to ask if there are any signs of iron-deficiency or bleeding, since those are not uncommon in older adults. I have low feritan stores and take one iron tablet a day because anymore gives me tummy pain and bloating. Whats the difference between low feritan and anemia? I am permanently tired still. Anemia means low red blood cell count. The body needs iron to make red blood cells, so iron-deficiency is one of many possible causes for anemia.
A low ferritin usually means abnormally low iron stores in the body. Also, after starting treatment, be sure to ask the doctor about the follow-up plan. If you have been taking iron tablets, has your ferritin improved? Has your anemia improved?
Please be sure to follow-up with your doctors soon. I recommend you ask about your latest lab results and make sure they know you are still feeling tired. I have no energy at all and I am 80 years old. Send me a message if you can on my facebook. I use to be so energetic and never stopped getting every thing done and never sat down. Now all I do recently is sit or lay down. This is not my normal self. There are many many different health problems that can cause a person to feel they have no energy.
I would strongly recommend that you contact your usual health provider, to get evaluated. I was placed in the hospital for anemia four years ago. I was bleeding on the lining and have a hiatal hernia. For six months I was exhausted. Second day feeling more energy. Slept 12 hrs instead of I now sleep normal hours.
She has had two bone marrow biopsies and skelaton xray. J Clin Oncol. They also diagnosed a bladder infection. All labs went up but the ferritin went down. Similarly, whether the hemoglobin will improve on its own depends on why it went down in the first place. Her HGB level was 7.
Older person taking iron. Factors that Increase the Risk of Iron Deficiency Anemia with Age
Once the cause of blood loss has been fixed, then if anemia is due to iron-deficiency, the blood count should improve within months. My father is He has hemoglobin level of His RBC count is a bit higher than normal range. Doctor gave him mg iron drip 2 weeks back. His Hemoglobin level is still We often give a fixed dose of approximately mg, which is generally sufficient to treat anemia typical red blood cell iron deficit between and mg and provide additional storage iron without causing iron overload.
Also, apparently IV iron interferes with most tests related to iron studies, so iron levels are not repeated during the month after administration of IV iron. Usually, the hemoglobin level starts to slowly improve after weeks, and one should see substantial improvement after one month. What medicine should I prefer? Is it danger to eat plenty? Eating slate pencils sounds like a condition called pica, which means craving and consuming non-food items.
Pica is associated with iron-deficiency anemia and other micronutrient deficiencies. It is unclear how often pica might cause deficiencies versus it being more a symptom caused the deficiencies. You can learn more here: A meta-analysis of pica and micronutrient status.
If you have anemia or blood loss, you need a thorough evaluation as described in the article, to determine what is the most likely cause of your low red blood cell count. It is impossible to know which medication or treatment is suitable until the underlying problem has been correctly diagnosed. Be sure to mention to your doctors that you have been eating slate pencils. The doctor told us she has severe Anemia. She refuses to eat anything.
Also she caughs a lot nowadays. She has lost all of her weight and is always exhausted. Is that normal? It sounds like your mother has lost her appetite for some reason. If someone has such symptoms plus coughing, normally we would investigate for serious underlying illnesses, especially those in the chest or lungs.
Usually the first step is a chest xray, and then possibly a CT. This can help rule out problems such as tuberculosis and certain cancers. Please note that I am not saying that she has a serious condition such as this, only that the symptoms you describe usually warrant some preliminary testing to check for such serious conditions. Be sure to ask your doctor what tests were done and which findings, other than low hemoglobin, were abnormal.
In order to help your mother get better, you will first need to learn more about what is causing her symptoms. Generally the best way to do this is to ask her doctors lots of questions and also keep doing your own research.
I do have an article on unintentional weight loss in older adults, see here: What to Do About Unintentional Weight Loss. My mom is 94 and in a nursing home. She was recently diagnosed with pneumonia. They are also treating her with antibiotics for the pneumonia. She has vomited several times after taking meds. When she is not sleeping, she is often agitated and confused. I want her to be comfortable but do not want to prolong her life. Is there a reason I should continue the iron supplements?
Yikes, that is pretty severe anemia. In my experience, if anemia is that profound and the goal is to try to extend life, then one needs to pursue a transfusion in the short-term. And that would be assuming that iron-deficiency is the main cause of the anemia and that the blood loss has stopped, which is often NOT the case for people like your mom.
However, if the goal for your mother is to keep her comfortable, then all that iron supplementation is unlikely to do that; it may well be contributing to her vomiting. Given her age and profound anemia, she is probably eligible for hospice care, and that is an excellent way to get medical care that focuses on comfort and managing symptoms, rather than trying against the odds to keep a person alive. You are absolutely doing the right thing in questioning what they are doing and researching other options.
Keep going and good luck! Hello mam I have haemogolobin 5. I gone through blood transfusion and then my haemogolobin is 9. I start to take iron pills on recommendation of doctor and eating more fruits and green vegetables. Now my haemogolobin 4 days ago is I have bad habit of not eating…..
Sorry that you have been having these health difficulties, but good that your hemoglobin is much improved. If your doctor is unable to find a reason, you may want to get a second opinion.
My mom is 72 years old and has been receiving blood transfusion on a monthly basis since May due to anemia. On top of this, she receives weekly injection of epokine units. It is exhausting for her; she is experiencing shortness of breath and fatigue. Her doctor has been recommending bone marrow test but my mom is so weak to undergo such invasive procedure. Just recently, we had her examine by a new doctor; stool exam was done and results show:.
I hate to think that we will result in getting her undergo a bone marrow test; is there any other tests we can do first? What we notice too that in the last two months, we needed to have her blood transfusion done earlier less than one month interval. A bone marrow biopsy is an important test, because it will provide a lot of information on what might be going wrong.
A bone marrow biopsy is usually recommended after a peripheral smear suggests that there is a bone marrow problem. Your mother sounds like she is experiencing a lot of symptoms from her anemia.
She just had another blood transfusion and we requested to get her ferritin test done early this week. We got an approval for this test but we are wondering if the recent blood transfusion may interfere with result of the ferritin test. More power to you and thank you very much for running this website. It is indeed an excellent website. According to this study, transfusion does not quickly change levels of ferritin, vitamin B12, or folate: The effects of blood transfusion on serum ferritin, folic acid, and cobalamin levels.
My friend,60 year old female was treated for severe anemia for over 18 months during which time they tried iron suppliments,checked for bleeding and gave her monthly infusions because the hemoglobin was usually down to There had been times when she passed out and had to be transported by ambulance to the ER where they gave her blood and discharged her.
Finally she changed doctors. A month later she was admitted to the hospital with a 2. The AML was resistant to chemo because of an invered 3 chromsone. She is now receiving alternate less strength chemo. Should not a bone marrow biopsy or reticulocyte count have been down at the very beginning?
Why go almost 2 years with infusions instead of determining the reason for the low hemoglobin levels? And to top it off the original treatment was with another cancer center. My mum diagnosed with myeloma last November. She has had two bone marrow biopsies and skelaton xray. No chemo as mum still able to do homebaking herself but had first blood transfusion when her reading dropped to 8. She is fine but they seem to be pushing her to go unto Aranesp mg injections which we as family after researching think is not great option.
She has had Mini stroke shortness of breath clots etc in past and think tranfusions would be safer option. It sounds like you are researching options, which is exactly the right thing to do.
I would recommend searching very high-quality sources of information on myeloma treatment, such as review articles in reputable journals. A second opinion from a doctor specialized in blood cell cancers may also help. In , I came down with a crash!
After that, a long painful uptake with a strict diet and spirullin kept me fatigued, depressed with skin outbreaks, hair loss, and general weakness for over two years. In , I started slowly to get better, with 20 ferritin, 24 iron but only An anemic person should give up coffee, black tea, alcohol, and preferably stick to a dissociated diet. And outdoor activities pumps the lungs and strengthens mind and body. Dietary changes to treat anemia really depend on what caused the anemia in the first place.
I am not aware of any studies indicating that people with anemia should give up caffeine or alcohol. Per the Mayo Clinic website , iron supplements are best absorbed on an empty stomach but may be taken with food in order to reduce stomach upset.
I received iron transfusion not blood transfusion. A transfusion will raise the hemoglobin quickly, whereas treating iron-deficiency or other underlying causes of anemia often takes weeks.
A transfusion is only a temporary fix, however. My haemogolobin was 5. And used to eat fried and spicy foods????? Can nutritional deficiency can be a reason????? You should ask your doctors to clarify why they think you became anemic, so that you can avoid recurrence of your anemia. Meat does contain iron and also vitamin B Both of these are necessary to make red blood cells. If you plan to remain vegetarian, be sure to ask your doctors to help you identify other ways to get these nutrients.
You may need to take iron supplementation indefinitely, if you have no dietary source of iron. I became anemic twice when I was a vegetarian, although with a better diet than Rajat. The first time my mother was overdosing us on zinc supplements, which binds with all heavy metals including iron. Learned about zinc issue from reading further than Prevention magazine. The second time was in Germany after a winter of drinking retsina in Greece in The naturopathic doctor in Germany recommended steamed stinging nettles, richest plant source of iron.
Pick them with gloves, from an isolated location, or buy dried. Rapid improvement. Thanks for sharing your story. In most people, oral iron supplements are an effective way to treat iron deficiency. However, certain foods interfere with iron absorption and medications that interfere with stomach acidity may also reduce absorption. It is also very common for people to experience unpleasant gastrointestinal side-effects from iron supplements.
Generally, the higher the dose of elemental iron in the supplement, the more likely people are to experience side-effects. Plants do contain iron but it is non-heme iron, which is actually less well absorbed by the body than the heme iron which is in meat.
A key to treating any type of iron deficiency is to check on how well the treatment is working, within a few weeks. If a person is able to raise or maintain their iron levels with a certain dietary approach, then additional iron supplementation may not be necessary.
This is a follow-up query on the case referred by Ms. Elaisa Tubana I am her aunt about my mother, 72 yrs old, who is suffering from anemia, and requires blood transfusion almost twice a month recently and a weekly injection of epokine.
We would like to know if its a must to have eight common follow-up test you mentioned above prior to bone marrow test. Accordingly, my mother do not have ferritin test yet. She only have so far the CBC which yield result on reticulocyte. Is it similar to peripheral smear. My mother will be having another blood transfusion this coming October 7 , including epokine injection. Likewise, the doctor is advising her to have the bone marrow test after the blood transfusion.
Kindly enlighten us on this. We need direction of whether we will proceed with the bone marrow test or have these 8 common follow-up tests first. Thank you and God bless. I will say that in the U.
A bone marrow biopsy is usually done after other tests have suggested a problem in the bone marrow. The purpose of this site is to provide information and education only, to help people ask better questions of their health providers.
Otherwise, for more specific direction, you would need to get a second opinion from a doctor who can work with your family in person, to examine your mother and review her test results so far. My mother is 83 years old.
She was dignosed with urinary tract infection. Her HGB level was 7. Does She need to improve HGB with injecting venofer? A urinary tract infection, in of itself, does not generally cause anemia, and usually treating a UTI does not, in of itself, cure anemia or raise the hemoglobin level.
Venofer is an iron infusion. Similarly, whether the hemoglobin will improve on its own depends on why it went down in the first place. If the problem was a bleed and the bleeding is stopped and the person has a well-functioning bone marrow and adequate iron stores, the body will eventually correct the anemia on its own. Last stage of Alzheimer, confined to wheelchair.
Has had CLL for over 30 years, but no tx, just monitoring. Three days ago, severe bruising appeared between morning and bedtime. Her right shoulder and chest were purple and the bruising progressed down her arm. CBC done….. WBC Can bruises appear spontaneously? Your article is very informative and I have copied the questions to ask about her anemia with the facility doctor.
Yes, it is possible for bruises to appear spontaneously. One potential cause is developing a low platelet count, which can happen with certain illnesses or serious conditions. The Mayo Clinic has a good article on bruising in late life here: Easy bruising: Why does it happen. They will also provide some support for you. My mother age 64 years has HB level 8. Now we are worried whether we should go ahead with this injection or not with the 2nd doctor telling this is a risky injection.
I googled up what cause of anemia is treated using this injection and it looks like this is when kidney is not producing some required hormone related to red cell production, when person has some kidney related disease. My mother never had any kidney disease and I suspect the doctor just prescribed the drugs based on 2 most common causes of anemia in elderly people. My mother is a diabetes patient and takes medicines for diabetes, blood pressure and thyroid in routine.
Doctor 1 who prescribed her medications is aware of her medical history and all the earlier medicines for these things have also been prescribed by him.
Can sometime tell me about the potential risks of this this injection Vintor IU and how risky it can be in worst case? Can my mother try some other things or tests to treat her low HB levels and get rid of the fatigue and tiredness she experiences daily? Is is possible to get the HB level improved or back to normal through natural things like diet and may be mild and relatively harmless supplements only?
The brand names you describe are not used in the US. It looks like Pevesca is alpha-linoic acid, which is an antioxidant sometimes used to treat diabetic neuropathy. You can ask the prescribing doctor if this is meant to treat anemia or some other problem your mother may be experiencing. As for Vintor, seems this is erythropoietin. People who develop chronic kidney disease may have lower than normal epo levels, which can cause or worsen anemia.
In the US, epo is mainly used to treat anemia that is associated with chronic kidney disease, or otherwise seems to be related to low levels of epo. It is possible to test blood levels of epo, but usually this is only considered if the person already shows signs of a condition associated with low epo.
This will help you understand whether treatment with epo is likely to help, and you can ask about the associated risks at that time. Many people with diabetes do develop some chronic kidney disease, so you should confirm your mother shows no signs of that on her labs. Chronic kidney disease is usually associated with higher than normal creatinine and blood urea nitrogen, and also lower than normal glomerular filtration rates. My mother has today taken 3rd of the 4 weekly injections prescribed.
She is complaining that she is feeling even more tiredness than earlier after taking these injections so far. So tomorrow we will get her HP count checked from lab. The doctor prescribing her erythropoietin would be better qualified to answer your question. The bone marrow usually takes about a week to create new blood cells, so presumably one should see some effect of this type of medication within a few weeks. Absolutely, by far, you are the best!! Thank you for this comment.
So glad you are finding this helpful. Can you review the bed bug article s and comment? A third unexplained in wake of current epidemic is outrageous, the insects have the ability to impact platelet count. Would you support an evidenced based policy for reporting? I think this is an exception, privacy rights need strengthening and subsidy for poor is sufficient incentive for self reporting, if privacy is respected! State medicaid could save so much if they intervened early.
I have met a lady who broke her back fallijg out of bed, and believe it was bugs that had her dauhter witlessly spend ten grand on lawyer to liquidate and sti ck her into semiprivate hell forever. The daughter confessed infestation etc. If excessive lab draws can effect CBC then thousands of animals sure can, and maybe costing golden decades. Although it is still within the healthy range as told by my doctor, which is , I am a bit worried.
My doctor said there is no need to worry because the overall index is still within the healthy range. As I grow older, does that mean my overall white blood cells will decline? What are the food to take fo increase my white blood cells, in pariicular Neutropjils and Lymphocytes?
Presumably this is because higher WBC counts can correspond to inflammation. Causes, consequences, and reversal of immune system aging. Presumably exercise, enough sleep, a healthy diet, social relationships, and all the other things we know are good for older people can help maintain the immune system.
Regarding vitamin B12, if you have concerns about deficiency then I recommend talking to your doctor about whether it might be possible to have your level checked. I will continue to monitor closely my TWC and the proportion of each different type of white blood cells in the sample for the coming years.
Haemoglobin 3. I will say that a hemoglobin of 4 is very very low, and in most cases such a low level prompts immediate transfusion. Therefore, she has to take omeprazole pills, about 2 or 3 times per day for few years since Once she stop taking or skip the pills for few days, she will develop symptoms like heartburn and her heart beat very fast.
This article is about anemia, not GERD. Some people do need to take proton-pump inhibitors PPIs such as omeprazole indefinitely but some patients are able to taper off of them. Hi, I recently had blood tests for symptoms of thrush and frozen shoulder and rang up for the results.
The receptionist told me that all was normal but my ferritin level was 10 and the doctor hadn,t reported on it yet. What does that mean. I have been told to ring back in a few days. I am a 66 year old female. A ferritin of 10 is pretty low, and is most commonly caused by iron deficiency.
Good luck and I hope your doctor is able to answer your questions and pursue further evaluation as needed. Can aspirin in general, and when taken at 3,mg daily for 2 weeks, cause anemia? Can any of the following meds they were taken at the same time as the 2 wk aspirin regimen cause anemia? Maybe the med combos can cause anemia…? Many thanks for this column and for offering interaction. It gives so many of us knowledge, empowerment and hope!
Taking that much aspirin every day sounds quite concerning to me. People can develop very serious acute aspirin toxicity by taking 10g of aspirin, so if a person were taking every day, I would be quite concerned about the possibility of chronic toxicity. I have to urge you to contact your doctors right away to review your aspirin use.
You may want to ask whether checking a blood salicylate level might be indicated. Otherwise, aspirin can cause anemia, usually by provoking bleeding. Good luck, take care, and be sure to discuss your aspirin use with a doctor or pharmacist before continuing to take this much daily aspirin. I would just like some insight about my father. He went to the doctor a few months ago, was diagnosed with anemia. Well this week he went to the doctor because he was sick it was just a cold.
They did blood work on him again. It came back that he is still anemic. They are sending him to a hematologist oncologist immediately. I do not have the numbers or any other specifics. My dad is diabetic and has been for 25 or more years. My question is, just because they want to send him to an oncologist does that mean he might have cancer? I know a year or so ago he had a lower gi done and they put him on a watch.
I appreciate your time. Hematology is the specialty related to blood cells and oncology is the specialty related to cancers. They have a lot of overlap, and there are some cancers of blood cells, such as leukemia. Historically hematology and oncology have been combined in a joint subspecialty internal medicine fellowship, so doctors will initially receive training in both specialties and then will take both the hematology board exam and the medical oncology board exam, so that they are board-certified in both specialties.
In practice, some doctors will do both hematology and oncology cases, but many end up focusing and re-certifying their boards in one or the other. So they are probably referring him to hematology, so that an expert in blood cell abnormalities can evaluate him. I will say that sometimes such blood cell abnormalities are related to some form of blood cell cancer, but there are other reasons for the various blood cells to look unusual. I would recommend that you and your parents try to always ask extra questions when you are told something is going on, or is abnormal.
This can be hard for older adults to do, so often adult children take on this role. It sounds low but not very low. That is assuming a woman is not pregnant. Pregnancy causes some anemia. My mom has had smoldering myeloma for approximately 7 years now.
Recently, she had a bone marrow aspiration because of a large drop in her hemoglobin, from She was rechecked two weeks later and it dropped to 9.
The bone marrow did not show evidence of Myeloma at this point. She was also tested for myodyplastic syndrome and this was negative as well. Doctor is stumped at this point. I believe blood loss is the most common cause of a sudden drop in hematocrit. If a person has normally functioning bone marrow, within a few days this should cause an increase in reticulocytes immature red blood cells , because the bone marrow will crank up red blood cell production in an attempt to compensate for the anemia.
In her case, the recheck was in the same range 9. Hi Doctor, In my hb was around 10 and I have diagnosed with ITP later in the month of April hb becomes 9 and in June July it got down into 8 and in the month of November it further reduced to 7. I have done endoscopy and colonoscopy where they have found helicobacter pylori like Bacteria. Now I have pain and cramps in stomach also I have hemorrhoids internal and external which is bleeding for last 6 years.
Now I am really worried please reply me. Sorry that you are having these symptoms and low red blood cell counts, it certainly does sound worrisome.
I am 77 years I have been getting procript injection for about 2 years every month then ever other month. I went and had a knee replacement and hemogloblin went from Then I had a blood transfusion which got it up to My iron is good.
I can not receive any more procript as insurance won. My kidneys are at 40 percent. He says I am good but I still am concerned. Do you have any opinion? Procrit is epoetin, an erythropoiesis-stimulating agent.
It seems that their target is based on their expert opinion and clinical experience, rather than on definitive randomized trials. You should discuss your concerns with your usual healthcare providers, as they know you and will also have relevant experience managing anemia in people with CKD. If you are concerned about your hemoglobin dropping while you wait for your insurance to resume covering Procrit, I recommend letting your doctors know, and asking what would be a reasonable way to monitor for any worsening of anemia.
My mom aged 46 is suffering from anemia 6. To increase blood levels. So I would recommend asking for more information on how they plan to do that. Usually to reduce her bleeding, they would need to first determine what is causing such heavy uterine bleeding.
For those who cannot tolerate oral iron, IV iron is sometimes required. Hello, and thank you for this useful information! I am a 66 year old woman and as a result of routine blood work done at my yearly physical, I found out that I have severe anemia.
The original HGB level was 7. Shortly after this diagnosis, I went to the hospital with a bowel obstruction my third , where I was given an infusion of iron. I am currently taking ferrex and have had an EGD and colonoscopy, both of which were normal. My RDW is high at My B12 and folate are normal.
Your thoughts, please. Thank you so much. Please see this comment and the article below, regarding iron deficiency anemia when endoscopy is negative.
It is not terribly rare, and you may eventually need additional evaluation. Outcome of endoscopy-negative iron deficiency anemia in patients above I would basically recommend you keep asking your doctors lots of questions as to what they think is going on, and what they plan to do next.
You may also want to consider a second opinion with either a hematologist or gastroenterologist. Shortness breath they say probably loss blood. I check motion. Can I take alternative like iron iamgood ateating food with iron just needed some one to. Talk with as I live alone no family now yourhelp would be appreciated Ruby.
For people with blood loss, iron is mainly helpful if they appear to be low on iron levels. If they tell you that you might benefit, but you might also be ok continuing as you are now, then you might feel better about what you are doing. Whereas if they strongly urge you to get further evaluation, you should take that under careful consideration. Especially if you have no family to help you think through this situation, you may want to see if you can find an online or in-person support group to help you.
You can connect with others who have a similar health condition at SmartPatients. Or a local center for older adults might have a group in which people can discuss health concerns and support each other. My 92 year old father has had a decrease in hemoglobin. I have limited information.
I believe his baseline is 9. He complained of itching and the doctor where he lives in senior living ordered blood tests. His hemoglobin came back 7. Apparently it was retested several days later and came back 6. The doctor wants to hospitalize him in order to do invasive tests to figure this out and after consulting with him and the rest of the family we have declined hospitalization.
What steps can we ask the doctor to take within his current living environment to diagnose what is wrong and keep him comfortable? We are not going to put him through anything invasive. I should mention he is in palliative care currently. Any information you could pass along would be greatly appreciated. It is often reasonable to decline hospitalization or try to avoid it if at all possible, for people in their 90s who live in a facility.
In terms of what can be done at his residence, it depends on whether the doctor can come see him at his facility, to ask more questions about his symptoms and to examine him.
It would also be common, for someone with a dropping hemoglobin, for a clinician to check the stool for signs of microscopic blood. In terms of keeping your father comfortable, we are often able to buy time and help someone feel better in the short-term by transfusing them with red blood cells.
This is sometimes done in an infusion center or even in an emergency room, but might be hard to arrange at the residential facility itself. In terms of whether this is an end-of-life situation: if his hemoglobin keeps dropping, then yes, this is a life-threatening situation.
If he is palliative care right now, perhaps you can find someone to help your family better understand what is going on? If he is not on hospice yet, you might want to consider it, because a good hospice team should be able to tell you what to expect, how he would be likely to die, and perhaps provide you with more support and guidance.
Good luck and take care. Hi, my dad recently was diagnosed with anemia caused by iron deficiency, He is on baby aspirin and plavix. He was alos taking Amitiza for good 10 years. For some reason his total cholesterol dropped down too. Are there any relationship between total cholesterol and iron deficiency?
Two month ago he had abdominal cat scan and it was perfectly normal. An abdominal CT can show some abnormalities and occasionally masses in the colon, but is not usually considered the best way to evaluate for bleeding in the intestinal tract.
For instance, dual antiplatelet therapy is beneficial to people who have had recent coronary stents, but most of the benefit is during the first months; after that the risk of bleeding may outweigh the likelihood of benefit. Dual antiplatelet used to be commonly used after strokes, but research indicates that this increases bleeding risk without usually reducing stroke risk compared to being on only Plavix. My father had hemoglobin 5. Iron normal, no bleeds found.
Told it is likely medications causing red blood cell destruction and bone marrow suppression. Plavix prevents blood clots and Xarelto is another type of blood thinner, so people taking both do have a risk of bleeding.
Red cell destruction usually causes an increase in indirect bilirubin levels can be seen on blood tests. Bone marrow suppression is often associated with a lower than expected reticulocyte count. This is an excellent, clearly-worded resource on anemia in the elderly. Thank you for sharing your time and expertise. About 2 years ago, my year-old mother-in-law complained of shortness of breath, severe fatigue, and headaches, and a blood count showed her to have very low ferritin count of 5.
Her doc ruled out any internal bleeding base on a negative FOBT and a chest CT, which showed that she has a large hiatal hernia but nothing else unusual. Could the supplements be masking an undiagnosed GI bleed or similar problem that should be investigated further? She has never had an endoscopy. Most experts recommend considering endoscopy, for evaluation of possible slow GI bleeding. Of course for some frail older adults, the likely risks and burdens of endoscopy outweigh the likely benefits; her doctors should be able to help your family discuss the likely risks of endoscopy and whether it makes sense for her to undergo them.
If her endoscopy evaluation is negative, then it might be reasonable to stop the iron supplements and see if she shows signs of blood or iron loss e. You might find this article relevant: Outcome of endoscopy-negative iron deficiency anemia in patients above I had two iron infusions and my iron level only went up a tad.
Doctor scheduled a 6 week follow-up. I am 74 yrs old. Hard to know what to say. I would recommend asking your doctor the questions in the article. How bad is your anemia and how did they conclude you were iron deficient? What is the cause of your iron deficiency and what kind of evaluation for possible bleeding have you had? Last but not least, you can find online communities of other people with your health condition, and they might help you figure out what to ask your doctor next.
My mother has anemia and they are getting nowhere helping her. She has to have a transfusion every weeks. She is getting tired and has talked about giving up several times. They have done several test, with no luck finding the cause. She has had a scope done up and down 2 times each, She had a bone marrow biopsy with negative results on that one.
It seems to me that her hematologist just gave up and now does nothing. What can be done about this? She is changing doctors in March but the new one is in the same office as her current one is in now. I though about taking her to another hospital, but she refuses to get the same test done over and over again. If her case is challenging, it can be better to go to an academic medical center, where the doctors often have deeper expertise or are otherwise more inclined to dig into the difficult cases.
I have been researching my symptoms and issues for a few weeks now and came across this publication. I beg to differ. I have never felt this way and wanted to share a couple numbers with you to seek advice. I am 33 years old, very active, work full time, and raise two children.
About a month ago, I started getting what I call head flutters, just odd sensations that would come and go throughout the day in my head, but no pain. I then started feeling chest pressure, my chest just feels heavy. I started looking over my results myself to see if anything showed any clues and saw a couple numbers that were borderline low normal so I wondered if maybe I could be borderline anemic? Is it okay to take an iron supplement to see if it helps? I appreciate any feedback. Here are the numbers that leaned towards the lower area of normal:.
Everything else was pretty much right in the middle, thyroid was definitely high normal though! They did not check my Vit D or check on the B12 or ferritin. Chest discomfort can be caused by a lot of things. If the pain gets worse or scary, obviously you should call Otherwise, you may want to ask the doctor if there is any possibility your symptoms could reflect heart problems, or some other issue affecting blood vessels e.
Conventionally trained doctors working in conventionally managed practices often have difficulty helping people in such situations.
From what you shared, seems to me very unlikely that anemia or borderline anemia would be the cause of your symptoms. If your symptoms persist, you will have to keep asking for help from medical providers. If your usual provider is not helpful, you will need to look into a second opinion, or perhaps a consultation with a provider who specializes in cases similar to yours. Functional medicine may well help. My father who is 57 went for an annual physical in the beginning of January.
He was diagnosed with Type II Diabetes. They also did blood work which showed iron deficiency. Ferritin 11 Iron 48 Iron saturation 11 Iron binding capacity unsaturated Iron binding capacity He went for a colonoscopy which found a 2 cm benign polyp, diverticulosis, and internal hemorrhoids. The doctor is also referring him for an upper endoscopy. I was just wondering your thoughts on these blood results. I am a PA student and I have learned to be worried about anemia in males, because it is usually due to something more sinister.
Is it possible that the anemia can be due to benign causes? He does have a history of taking Naproxen Sodium regularly. Is it possible he can have an asymptomatic bleeding stomach ulcer?
Sorry for the novel. I just get nervous. Especially because my uncle had anemia and was ultimately diagnosed with pancreatic cancer not related by blood to my father. Yes, he could certainly have an ulcer or bleeding from somewhere else in his GI tract. My dad had repeat blood work after being on the iron pill once a day for about 3 months he took the pill with meals, which he was unaware that it is better absorbed on an empty stomach. The results were:.
All labs went up but the ferritin went down. He was also placed on an 81 mg aspirin daily at this time. He just received an upper endoscopy which showed no evidence of a bleed. If it is negative, they are going to continue supplementation and monitor. We are also waiting for the results of the biopsies taken from the endoscopy. My question is if you think this is a reasonable course to go? Could the aspirin been effecting these numbers?
Is there anything else we should test? So confused as to why he is iron deficient and so nervous that we may be missing something. His blood count overall is not that low, but his ferritin does seem quite low. You may want to ask them to discuss with you the likely benefits and risks of taking the aspirin at this time. It is a risk for new or continued bleeding, so it might help for the doctors to clarify how important it is for him to take it at this time.
I am interested in mild anemia and came across your site. I had been having symptoms of a headache after exercise or exertion. However, a blood retest in Jan revealed levels are back to normal but in the starting range, 4.
The doctors say that anemia is not there. But I still have symptoms, tension headaches on exertion, an irregular heartbeat at times. Does these reading sound like mild anemia? So not sure if these are symptoms of underweight or something else. I also noticed blood in stools for the past 2 years. But cannot be sure if it was blood. I have anxiety and the doctors are not able to isolate the issue. I am concerned about any advice from you would help. If they are persisting, then you should definitely keep working with your doctors to figure out what is causing your symptoms.
If you have noticed an irregular heartbeat at times, you should be sure to mention this to your doctors. There are usually ways to monitor the heart for several days via a wearable patch or other special device ; something like this could help determine what is going on with your heart when you experience symptoms. Thanks for the advice. I Have been seeing different specialty doctors but they have not been able to pont the finger to any one cause for the headaches.
I have done done holter and all other heart related tests. They are fine. Only minor jha plaque in artery. I was more concerned if there is any Undetected cancer colon that is had caused the weight loss. And is beginning to show some symtomps.
If you are concerned about undetected cancer, then I would recommend bringing that up with your usual doctors. They would be best positioned to advise you on how to address this concern, and what might be signs of cancer given your situation. Unintended weight loss certainly is a concerning symptom, however, if your weight has stabilized since , that sounds somewhat reassuring. Of course, if you are experiencing worrisome symptoms, then you need to keep asking your health providers for help, or consider seeing a different type of doctor.
In the US, some clinicians in functional medicine have had good success in evaluating these cases, because they have a more careful and thorough approach than conventional doctors do. Thanks for your input Dr. Do you know of any good functional medicine doctors in the US that i can reach out to that can help. Im 65 and diabetic A1c around 6. So my question is. Something changed after weight loss — and no matter what I eat im at a solid lbs was at any clue 2, Shoulder replacement required — started advil around may timefram — could that be a problem 3.
How far can they take this testing — sounds like an endless process 4. Would all my other CBC results be normal if there was an issue? A colonoscopy inspects the colon but not the small bowel or stomach, both of which can be sources of bleeding. If there is a slow chronic bleed, often other tests related to iron-deficiency anemia e.
Be sure to keep asking your doctors lots of questions, they are best positioned to help you figure this out. Will read more of this excellent site before asking about possible reasons for low haemoglobin. Then will go back to my new GP and possibly ask questions of my gastroenterologist who wants me to have a colonoscopy.
My age 84 and live entirely alone. Thanks, Judy. I would also recommend going to your medical appointments with a family member or trusted friend. Eats very little, aenimic,angina problems. Haemoglobin drops every few months. She gets blood transfusion. Why would they let it drop to 6, before deciding she needs a transfusion. Hm, well I would recommend you ask the involved providers to explain their reasoning for why they wait until a hemoglobin of 6 rather than 7.
Some research generally done in hospitalized patients, not nursing home patients suggests a transfusion threshold of 7 is acceptable, so perhaps they are waiting for her to drop just below 7 e. I hope they have explained to you why she has these persisting drops in hemoglobin.
If not, I would recommend asking questions as this sounds like an important issue to address. This has been the most helpful article I have come across in my search for answers to my anaemia! I have been suffering for at least five years and unable to get my levels up. Living in Greece is not easy and much research is done on our part.
My latest readings are haematocrit 33,1, RCC , haemoglobin 10,5, serum iron 61 and ferritin 14,5. The doctor has prescribed ferrous glutonate but should I be pushing for a colonoscopy and endoscopy?
Any advice would be greatly appreciated. Well, the main thing I recommend pushing for is an explanation. A hemoglobin of Your health providers should be able to help you with an evaluation and an explanation. They said a three month course of iron tablets for Normocytic anaemia should sort her out, and it did, bloods back to within normal range and all she felt better in herself, less lethargic, picking up less colds etc.
At what point do we push this? Her WBC count is borderline low, so it may or may not be of significance. What is more interesting to me is that you say her blood count got better with iron supplements. So, you may want to ask them if she had signs of iron deficiency e. If she is iron-deficient now, the question would be why. Need your good advice urgently. My mom is 88 years old, she has been diagnosed with low blood count, about 8 points and also irregular heart beat. Few days ago she had a mild heart attack.
Heart doctor wanting to give blood thinner to her but worry she might have internal bleeding that causes her anemia. We are reluctant to do colonoscopy given her age. To us, currently she looks pretty fine except a bit weak. Taking a blood thinner does increase the risk of internal bleeding, or can worsen an existing small bleed. Is there a very big and important benefit in taking the blood thinner right away?
This is the kind of question you need to ask her doctors; I cannot answer it because it depends on her particular health circumstances. If not, then it may make sense to wait a bit and try to find out why she became so anemic. Your doctors should be able to tell you whether a colonoscopy is likely to be very risky given her age and condition. There are also other ways to check for internal bleeding.
Last but not least, waiting for a period of time and seeing if the blood count stabilizes is another potential approach that can be used. Thanks for your advice. Pls let me know what other ways to check for internal bleeding? They should be able to test her stool to see if there are signs of microscopic blood. Also, you can ask whether her ferritin was low, or did she have other signs of iron loss. It often does make sense for older adults with afib to take blood thinners; whether the likely benefits of her starting one right away outweigh the risks , compared to perhaps waiting a few weeks; this is one thing you might discuss with her doctors.
I have been told I have anemia blood count Ask your doctors to explain what they think is the cause of your anemia and you may want to ask if you show signs specifically of iron deficiency.
I am a 65 year old female and in great health I thought. Out of curiosity I started taking my blood tests and have become concerned about anemia. I am quite active and not tired at all but my Hb ranges from 8. This seems quite low, but with no obvious symptoms or fatigue or weakness I wonder if I need to explore it further?
I have always had fairly low blood pressure. I climb mountains, work on a farm, exercise regularly and am fairly lean. In case of accidental overdose, call a doctor or poison control center immediately. Statements on this page have not been evaluated by the Food and Drug Administration.
This product is not intended to diagnose, treat, cure or prevent any disease. About Who Needs Iron? Who Needs Iron? Iron for Seniors. Why do seniors need iron? High intake of calcium. Low intake of heme iron the kind that is absorbed better and found in animal foods including meat, poultry and fish. Certain chronic diseases and other conditions can affect iron status.
Iron nutriture in elderly individuals. Iron in Diet. Medline Plus, NIH. Aspirin as a therapeutic agent in cardiovascular disease. Circulation ; Iron status of the free-living, elderly Framingham Heart Study cohort: an iron-replete population with a high prevalence of elevated iron stores. Am J Clin Nutr ; Anemia — Complications.
University of Maryland Medical Center.
Frontiers | Iron deficiency in the elderly population, revisited in the hepcidin era | Pharmacology
Iron deficiency ID is relatively common among the elderly population, contributing substantially to the high prevalence of anemia observed in the last decades of life, which in turn has important implications both on quality of life and on survival. In elderly subjects, ID is often multifactorial, i. Moreover, because of the typical multimorbidity of aged people, other conditions leading to anemia frequently coexist and make diagnosis of ID particularly challenging.
Treatment of ID is also problematic in elderly, since response to oral iron is often slow, with a substantial fraction of patients showing refractoriness and requiring cumbersome intravenous administration. In the last decade, the discovery of the iron regulatory hormone hepcidin has revolutionized our understanding of iron pathophysiology. In this review, we revisit ID among elderly people in the light of the impressive recent advances on knowledge of iron regulation, and discuss how hepcidin may help in diagnosis and treatment of this common clinical condition.
Anemia is a common, multi-factorial condition in elderly. Indeed, the prevalence of anemia increases with age, representing an important health problem among older individuals. One of the largest population survey, i.
These fractions rose to There is some debate on which hemoglobin Hb threshold should be used to define anemia in the general population and particularly in elderly individuals Beutler and Waalen, However, these criteria have been criticized since they were based on statistical distributions i. Nevertheless, it is associated with a variety of adverse outcomes, including longer hospitalization, disability, and increased mortality risk Chaves et al. Approximately, one-third of the cases of anemia in elderly can be ascribed to a chronic disease inflammation and chronic kidney diseases , and one-third is due to nutrient deficiencies folate, B12, and iron.
Iron deficiency ID , alone or in combination with deficiency of other nutrients, accounts for more than one-half of this group. Thinking in terms of multimorbidity is a key to understanding, diagnosis, and treatment of anemia in the elderly. Besides the large number of children and young women affected in developing countries, ID is the only nutrient deficiency that is also significantly prevalent in industrialized countries [ World Health Organization WHO , ; Hershko and Camaschella, ], where an additional category at risk is represented by elderly people Guyatt et al.
Iron deficiency syndromes include a range of different conditions Goodnough, In physiological conditions, the total body iron amount near 3—4 g is maintained by a fine balance between three distinct factors: body requirements, iron supply depending on dietary iron intake and duodenal absorption , and blood losses.
This phenomenon is often related to an impaired iron trafficking i. Since the focus of this article is on etiology, diagnosis, and management of the absolute ID in elderly, the readers are referred to others excellent reviews for details on the functional ID syndromes Goodnough et al. Whatever the mechanism, both absolute and functional ID reduce iron availability to erythroid precursors, with the development of an iron-restricted erythropoiesis, and finally of anemia.
In particular, two ID stages can be distinguished: a initial, characterized by reduced transferrin saturation but without anemia; and b advanced, when microcytic, hypochromic iron-deficiency anemia IDA becomes evident. In elderly, ID and IDA are nearly always due to chronic GI diseases, which in turn lead to iron loss and malabsorption not infrequently occurring in combination at individual level Figure 1.
Indeed, the most frequent cause is represented by chronic upper and lower GI blood losses , because of esophagitis, gastritis, peptic ulcer, colon cancer or pre-malignant polyps, inflammatory bowel disease, or angiodysplasia Eisenstaedt et al.
The prevalence of most of these conditions increases with age, which is particularly true for neoplastic lesions Eddy, and angiodysplasia Sami et al. Remarkably, GI bleeding is typically increased by concomitant assumption of medications for conditions highly prevalent in elderly individuals, such as non-steroidal anti-inflammatory drugs for osteoarthritis, and antithrombotic therapies for cardiovascular disease, especially for atrial fibrillation.
Of note, more than one of these conditions not infrequently coexist in a given individual. Bleeding is often favored by antithrombotic drugs for treatment of cardiovascular diseases that are highly prevalent in this age group.
Suggested diagnostic tools are reported on the right side. Iron malabsorption is also relatively frequent in the elderly.
Indeed, further conditions whose prevalence typically increases with age are represented by Helicobacter pylori HP infection Pounder and Ng, and atrophic gastritis. Of note, although, for a long time, celiac disease CD has been primarily considered an enteropathy of childhood and young adults, a number of epidemiological studies have reported an increased detection rate in older subjects, with up to one third of newly diagnosed patients being older than 65 years Patel et al.
In this age group, multifactorial anemia is the most frequent clinical presentation Harper et al. For poorly understood reasons, the classical triad of malabsorptive symptoms including diarrhea, weight loss and abdominal pain is less common in elderly Freeman, , making the diagnosis frequently overlooked in this age category.
Another factor that could theoretically contribute to iron malabsorption in elderly patients is represented by the frequent long-term use of proton pump inhibitors PPI , being gastric acid essential for optimal intestinal absorption of the element Ganz, However, only few reports have specifically addressed this issue, which remains controversial Reimer, These conditions should be always considered in elderly subjects with IDA and no evidence of GI blood loss.
Finally, malnutrition is an obvious contributing factor to ID in elderly. Hepcidin, a defensin-like hormone synthesized mainly by the liver, has been discovered in and recognized as the master regulator of iron metabolism Ganz and Nemeth, The active form of hepcidin is a amino acid peptide derived from an 84 amino acid precursor, but at least two others isoforms truncated at the N-terminus, i.
The biological meaning of these isoforms is still unclear Campostrini et al. Hepcidin acts by binding to its receptor, the transmembrane protein ferroportin, which currently represents the only known cellular iron exporter in mammals De Domenico et al. In humans, ferroportin is mainly expressed in cells playing a key role in iron homeostasis, like duodenal enterocytes absorption of dietary iron , in splenic and hepatic macrophages recycling iron from erythrophagocytosis , and in hepatocytes iron stores.
The hepcidin-ferroportin binding induces the endocytosis and the lysosomal degradation of both molecules, resulting in decreased intestinal absorption and release of iron from recycling macrophages, both ultimately leading to reduction of plasma iron concentration Ganz and Nemeth, Regulation of hepcidin synthesis is quite complex and includes a number of different pathways [for recent detailed reviews see Ganz and Meynard et al.
ID and increased erythropoietic activity down-regulate hepcidin production, and suppressed or very low hormone concentrations are observed in IDA or anemias with high erythropoietic activity Ganz et al. Although the nature of the suppressive signal is still unknown, there is some evidence that, at least in conditions of stimulated erythropoiesis, it could be represented by a circulating factor produced by the erythroid progenitors in the bone marrow Kautz et al.
On the other hand, hepcidin is strongly induced by inflammation Nemeth et al. Nevertheless, recent studies in mouse models Gardenghi et al.
Currently, two main methods are available for measuring hepcidin in blood and urine, immunoassays based on anti-hepcidin antibodies, and mass spectrometry MS -based assays Castagna et al.
The latters are generally preferable, being able to distinguish the iron bioactive mer isoform from other isoforms of uncertain significance, at variance with the incomplete specificity of available antibodies Castagna et al. Serum hepcidin shows well-defined age- and sex-specific variations at population level as illustrated below Galesloot et al.
In this context, hepcidin could theoretically play a substantial role, considering its involvement both in inflammation and in the regulation of iron availability for erythropoiesis.
After the menopause, hepcidin levels tend to be similar in both sexes, with a slight decrease in the eldest groups. Although not specifically designed to study the anemia of elderly, these studies tended to exclude a sustained increase of hepcidin in elderly.
Accordingly, two studies in elderly anemic patients have failed to detect increased hepcidin levels in urine Ferrucci et al. Serum hepcidin A and ferritin B levels stratified by decades in healthy subjects older than 50 years. Subjects were from the Val Borbera study, a large population survey including subjects. Adapted from Traglia et al. Several reasons may account for these discrepancies on hepcidin levels in elderly anemic subjects, including the different laboratory methods and clinical settings Goodnough and Schrier, Most of the data are retrospective, and properly designed, large-scale, studies are required before drawing definite conclusions.
For the moment, the available evidence has generally downsized the initial hypothesis on hepcidin as a major determinant of the unexplained anemia of the elderly. This remains likely a complex condition due to the combination of several age-related changes, such as stem cell aging, low-grade chronic inflammation, subclinical impairment of kidney function, androgen insufficiency, and others still unknown Guralnik et al.
Several guidelines and recommendations have been proposed for the diagnosis of IDA in the general population Cook, ; Goddard et al. Being GI diseases the most common causes of IDA in elderly Figure 1 , the diagnostic work-up should often, at least theoretically, include relatively invasive investigations, like endoscopic procedures.
This is particularly true since, for example, IDA in elderly often herald the presence of an occult GI malignancy. Of course, old age per se is not a contraindication to such procedures, but a particular clinical skill is required in each individual and frail elderly patient to thoroughly evaluate the risk-benefit ratio as well as the prognostic implications.
Anyway, while the diagnostic work-up should be, whenever possible, comprehensive, some conditions deserve peculiar attention in the elderly patient presenting with IDA.
In our experience, a condition particularly challenging is represented by GI angiodysplasia, which in turn is a potentially treatable disease Richter et al. Remarkably, bleeding in GI angiodysplasia is often discontinuous, with possible false negativity of occult fecal blood test.
In this case, additional testing by video capsule endoscopy VCE is needed Sami et al. Finally, a distinct feature of GI angiodysplasia is its frequent association with another relatively common condition in elderly, i. Being the latters the most hemostatically competent form of von Willebrand factor, this favors a vicious circle that aggravates the bleeding from GI angiodysplasia and the consequent IDA.
From a laboratory point of view, an accurate diagnosis of IDA in elderly is also challenging because of the high prevalence of concomitant chronic diseases that complicate the interpretation of traditional biomarkers.
The red blood cells mean corpuscular volume MCV is often a starting index in the evaluation of a patient with anemia, being typically reduced in IDA. Indeed, in these subjects true ID often occurs at higher ferritin values, since ferritin per se raises with aging Casale et al. The low sensitivity of traditional iron biomarkers is demonstrated also by the fact that elderly anemic patients sometimes respond to iron supplementation even if their iron indices at baseline are not abnormal Price et al.
Soluble transferrin receptor sTfR , derived from proteolysis of the membrane transferrin receptor TR , reflects erythropoietic activity and inversely correlates with the amount of iron available for erythropoiesis. In the past, some evidence supported sTfR measurement as a novel marker of ID in older people, considering that its levels do not increase with age and are not affected by the presence of inflammation Mast et al. However, currently the lack of standardized reagents for the sTfR assay complicates interpretation of the sTfR-ferritin index in different studies, and limits its use in clinical practice Pfeiffer et al.
In the last decade, hepcidin has been suggested as a promising diagnostic marker for iron-related disorders Goodnough et al. In IDA serum and urinary hepcidin levels are typically reduced and frequently undetectable by currently available assays Bozzini et al.
Hepcidin suppression appears also a sensitive indicator of ID without anemia, since decreased levels have been observed prior to a detectable decrease in Hb or hematocrit Ganz et al. As mentioned above, hepcidin is induced by inflammatory cytokines and contributes to the pathogenesis of the so-called anemia of chronic disease ACD , which is characterized by impaired iron utilization, along with inadequate EPO production, and cytokine-induced inhibition of erythroid precursors Weiss and Goodnough, The opposite trend of hepcidin in IDA versus ACD has theoretically the potential to differentiate these conditions, both highly prevalent in elderly, and not infrequently coexisting.
Of note, preclinical studies have shown that concomitant ID tends to blunt the hepcidin response to pro-inflammatory cytokines Theurl et al. Preliminary data in patients with rheumatoid arthritis van Santen et al. Currently, no specific guidelines exist for the management of anemia in the elderly. A recent review recommends that iron status should be checked at first in every elderly patient Goodnough and Schrier, Once IDA is clearly ascertained or deemed likely because of ambiguous results of iron markers as discussed above a therapeutic trial with oral iron should be prescribed, with the aim of correcting both anemia and iron stores.
This first-line approach, preferably using divalent compounds like ferrous sulfate or gluconate because of their superior bioavailability Clark, , is usually considered to be safer for the patient and with a better cost-effective ratio as compared to parenteral iron administration. The time needed may be even longer in elderly patients, because of slower bone marrow response. This translates in poor adherence, particularly when concomitant multimorbidity requires the assumption of a huge number of pills per day.
Moreover, oral iron supplementation is often poorly tolerated in elderly patients, particularly because abdominal discomfort, as well as poorly absorbed because of the relative high prevalence of malabsorptive conditions see above. Most IV iron formulations are generally effective, well tolerated, and with a lower incidence of serious adverse reaction e.
Until a few years ago, the most widely used formulations in Europe were iron gluconate or iron sucrose, which are relatively unstable compounds with limited maximal doses per single infusion, i. Since the mean total iron dose generally required to correct anemia and restore iron is — mg, multiple hospital accesses for repeated infusions are needed. In elderly patients with limited autonomy, this not only increases direct and indirect social costs, but also can substantially hamper the feasibility of the treatment.