Small‐dose oral iron absorption test in anaemic and non‐anaemic elderly hospitalized patients

Abstract

The small‐dose (20 mg) oral iron absorption test (OIAT) was performed in 76 hospitalized elderly patients and 30 healthy adults. Of the elderly patients, 34 were considered as iron deficient (serum ferritin level <20 μg/L) of whom 23 were anaemic and 11 not anaemic, 21 had the anaemia of chronic disorders (ACD) and another 21 were non‐anaemic patients with a normal serum ferritin level. There was a significant inverse correlation between the serum ferritin level as a measure of iron store and the maximum increase in serum iron during a 3‐h test (Cmax), in the elderly as well as in the healthy adult group. A decision limit of 80 μg/dL for Cmax is a good discriminant between absent (serum ferritin <20 μg/L) and adequate body iron stores. Sixty‐eight per cent of the patients with a serum ferritin level <20 μg/L but virtually none of the ACD patients, non‐anaemic elderly inpatients with normal serum ferritin levels and healthy adults had a Cmax level >80 μg/L. Although further investigation is needed before the OIAT can be recommended as a valuable test for evaluating iron absorption, predicting mild iron deficiency and differentiating between different categories of anaemia, it seems worthwile that more effort should be done to validate this simple and safe test.

Guidelines for the management of iron deficiency anaemia

“…This is achieved most simply and cheaply with ferrous sulphate 200 mg twice daily. Lower doses may be as effective and better tolerated46 47 and should be considered in patients not tolerating traditional doses. Other iron compounds (eg, ferrous fumarate, ferrous gluconate) or formulations (iron suspensions) may also be tolerated better than ferrous sulphate.…”

Iron deficiency anemia in older adults: A review

“…33,34 To what extent the association of a low transferrin saturation to the serum ferritin level might increase the diagnostic accuracy for iron deficiency is unclear. 46,47 A bone marrow smear with Prussian blue is generally considered as the gold standard investigation for the diagnosis of iron deficiency, but it is invasive and uncomfortable for the patient, the interpretation can vary significantly between investigators, and it is in general not a part of the diagnostic work-up of the anemic older patient. 28 A combination of non-iron related parameters, such as C-reactive protein and the erythrocytic sedimentation rate, as markers of inflammation can be useful to estimate the effect of inflammation in IDA patients, but it is not exactly known which cut-off points should be used.…”

The role of blood transfusion in the management of upper and lower intestinal tract bleeding

“…Ferrous sulphate at a dose of 200 mg bd will usually achieve the treatment aims, but lower doses may be as effective and better tolerated. 59,60 The BSG guidelines recommend using oral iron for 3 months after the iron deficiency has been corrected to fully replenish stores. Parenteral iron should be reserved for those intolerant of, or non-compliant with oral iron.…”