View Large Download. J Am Geriatr Soc. Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient. Am J Med. Diagnosis of iron-deficiency anemia in the elderly. Am J Clin Nutr. N Engl J Med. Am J Clin Pathol.
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J Lab Clin Med. Punnonen KIrjala KRajamaki A Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Punnonen KIrjala KRajamaki A Iron-deficiency anemia is associated with high concentrations of transferrin receptor in serum. Scand J Clin Lab Invest. Cermak JBrabec V Transferrin receptor—ferritin ratio: a useful parameter in differential diagnosis of iron deficiency and hyperplastic erythropoiesis [letter]. Eur J Haematol. Suominen PPunnonen KRajamaki AIrjala K Serum transferrin receptor and transferrin receptor—ferritin index identify healthy subjects with subclinical iron deficits.
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See More About Geriatrics Hematology. Save Preferences. Med J Indones ; Abstract The numbers of older people in the world have been growing rapidly. Anemia is the most common hematologic problem encountered in older adults. However, anemia should not be accepted as an inevitable consequence of aging. Anemia in the elderly signifies an underlying disease. IDA in the elderly is often associated with such non specific symptoms.
The diagnosis of IDA is typically based on laboratory results. Hence, the utilization of the various laboratory tests plays an important role for the diagnosis of IDA. The presence of IDA in the elderly is usually related with gastrointestinal disorders.
Thus, gastrointestinal evaluation should be contemplated in all patients with IDA unless there is a history of clinically important non gastrointestinal blood loss. Older people with IDA should have iron supplementation both to correct anemia and to replenish body iron stores.
However, the underlying cause should always be treated to prevent further iron loss. Med J Indones ; Key words: anemia, elderly, gastrointestinal, iron deficiency Anemia is defined as a reduction in the number of circulating Iron Deficiency Anemia IDA outranks the anemia red blood cells, or the hemoglobin concentration in the of chronic disorders in prevalence, but the reverse is blood.
Anemia is extremely frequent in symptoms, and investigations may help in detecting an elderly persons, defined in this article as those aged 65 occult gastrointestinal pathology such as malignancy. With advancing age, there is The bone marrow is the site of production for blood cells, a progressive and apparently physiological decrement of such as circulating RBCs, granulocytes, and platelets. However, anemia in the elderly As aging proceeds, the marrow becomes increasingly is due to disease and should never be considered as a localized to the axial skeleton.
However, in the non- normal physiological response to ageing. Consequently, clinical examination of anemia of chronic disease and iron deficiency anemia the marrow of older persons does not differ from that being the most common causes. In community studies, of normal young adults. However, anemia is not only by laboratory survey.
Although the impact of IDA a consequence of aging. This supports the concept that on the quality of life of the subject is high, they often older persons develop anemia due to underlying disease. The patient becomes aware of an improvement only when the symptoms disappear. These changes were caused by reduction to diet, but is usually a result of digestive disorder. Some older people could have gastrointestinal origin can be divided into two groups: other signs, such as cheilosis fissures at the corners situations with increased loss of iron and those with of the mouth and koilonychia spooning of the decreased iron absorption.
In the former, there could fingernails. The presence of these signs suggests that be a hidden bleeding, which might be more difficult there might be an advanced tissue iron deficiency.
Common causes include NSAID use, Physical examination might be normal or show pallor colonic cancer or polyp, gastric cancer, angiodysplasia, of varying intensity.
Besides that, there might be a and inflammatory bowel disease. Rare causes include systolic murmur in cardiac auscultation. There are various measurements of iron status. No single measurement is ideal for all clinical In the second category of etiology, reduced iron circumstances, as all are affected by confounding absorption can be caused by celiac disease, atrophic gastritis, factors. Hence, the utilization of the various laboratory and postsurgical status gastrectomy, intestinal resection.
In a study on patients referred to gastroenterologists because of IDA, celiac disease was the diagnosis in 1. Microscopic alterations in the The World Health Organization WHO defines duodenal mucosa in non-treated celiac disease will anemia as the decline in blood hemoglobin to a lead to a refractory condition in oral iron treatment. The diagnosis of anemia needs complete gastritis with or without H. The positivity of blood count examination, including a measure of autoantibodies anti-intrinsic factor or anti-parietal the mean corpuscular volume MCV.
In this way, cell supports the diagnosis of autoimmune atrophic the anemias can be characterized morphologically gastritis. A recent meta-analysis concluded that the as normocytic, microcytic, or macrocytic. Faced infection of H. The mechanism is not clear, but it appears diagnostic possibilities include iron deficiency to involve gastrointestinal blood loss, diminished iron anemia IDA , thalassemia, anemia of chronic absorption from the diet, and increased consumption of disorders, and sideroblastic anemia.
The next step iron by the bacteria. Serum iron SI and total iron binding capacity TIBC The clinical presentation of IDA depends on the degree The SI level represents the amount of circulating of anemia, the speed of onset, the underlying cause, and iron bound to transferrin.
The TIBC is an indirect the presence of comorbid conditions. IDA in the elderly measure of the circulating transferrin. The SI and is often associated with such nonspecific symptoms as TIBC give a measure of the iron supply to the general weakness, fatigue, functional decline, irritability, tissues.
In normal subjects, SI shows a diurnal poor concentration and headache. In iron deficiency, however, hemoglobin synthesis. A low SI of red cells. A serum transferrin indicate iron deficiency. Convenient analysers measure erythropoiesis, indicates iron deficiency states.
Serum ferritin the protoporphyrin exists in iron deficiency. All patients underwent evaluation by means of a detailed medical history and results of complete physical examination, routine blood tests, and specific tests for diagnosis and evaluation of anemia.
Examination of bone marrow aspirate was performed for all patients. Levels of transferrin receptor in serum were determined by means of a specific enzyme-linked immunosorbent assay.
The most common medical diagnoses with iron deficiency from those with anemia of chronic aside from anemia , and the number of patients af- disease were examined. The likelihood ratios for RDW fected, were as follows: early dementia, 25; congestive 0 to 15, 15 to 19, and greater than 19 were 0.
Ferritin proved a far more pow- matoid arthritis, 17; osteoarthritis, 14; pneumonia, In the logistic regression model, ferritin was the best Number Iron- Number Not Likelihood predictor of bone marrow iron stores.
The only test Interval Deficient Iron-Deficient Ratio that explained a statistically significant additional portion of the variance was the transferrin saturation. All seven of these patients proved to be iron-deficient. Of the five patients with liver disease rg5 i: 8. Of the six iron-deficient subjects Red cell protoporphyrin with rheumatoid arthritis, five had a serum ferritin 2 0 IO.
However, the numbers of patients Total 84 with these conditions were insufficient to permit strong inference regarding the issue of differences among subgroups. Ferritin positive, 1 However, in our population, even MCV 3nly four cases were serum ferritin-negative and transferrln saturation-poshve.
It may also reflect the high preva- should be interpreted differently from serum ferritin lence of chronic disease in the elderly, although only a results in younger patients; and that when the infor- small proportion of our population had inflammatory mation from the test is optimally utilized by means of conditions thought to be associated with increased lev- multi-level likelihood ratios , the test is extremely els of serum ferritin.
The clinical usefulness of of this manuscrrpt. Dr Anne Benger for help wrth rnterpretatron of bone marrow the likelihood ratios associated within different re- aspirates; and Sue Halcrow. Sandi Harper, Jenny Whyte. Table help with data collectron. The power of the 2. Frenkel EP: Evaluatron of a packaged ktt assay of serum ferrrtrn and applicatron to clinrcal dragnosrs of selected anemras.
Am J Clrn serum ferritin level is made evident by examining the Pathol ; Can Med Assoc J ; Mazza J. Let concentratron rn the detection of iron defrcrency rn a general hosprtal. Can Med us assume a physician is willing to diagnose a patient Assoc J ; Ludwig J: Serum ferrrttn, cobalt excrebon and body iron status.
Under these cir- overload. J Clrn Pathol ; Finch CA: A clinrcal evaluation of serum ferrrtrn as an Index of iron stores. N Engl J Med ; Pine R, The Influence of age upon serum Iron rn normal subjects.
J Clin Pathol ; 5: Am J Clrn Nutr ; The results depicted in the last column of Table IV
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