Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2000 Apr;76(894):195–198. doi: 10.1136/pmj.76.894.195

Does this elderly patient have iron deficiency anaemia, and what is the underlying cause?

O Jolobe 1
PMCID: PMC1741560  PMID: 10727560

Abstract

Important implications for the recognition of iron deficiency anaemia include diagnosis and correction of underlying causes, most of which are identifiable, in the older patient, by means of conventional upper gastrointestinal endoscopy, and by colonoscopy. The aetiological search may, however, have to be widened to include enteroscopic examination of the jejunum and ileum and, in some instances, investigation of potential non-gastrointestinal foci of chronic blood loss. A substantial minority may defy even the most thorough search for the underlying cause.


Keywords: iron deficiency; validation; underlying causes

Full Text

The Full Text of this article is available as a PDF (137.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alemayehu G., Järnerot G. Same-day upper and lower endoscopy in patients with occult bleeding, melena, hematochezia, and/or microcytic anemia. A retrospective study of 224 patients. Scand J Gastroenterol. 1993 Aug;28(8):667–672. doi: 10.3109/00365529309098269. [DOI] [PubMed] [Google Scholar]
  2. BAINTON D. F., FINCH C. A. THE DIAGNOSIS OF IRON DEFICIENCY ANEMIA. Am J Med. 1964 Jul;37:62–70. doi: 10.1016/0002-9343(64)90212-8. [DOI] [PubMed] [Google Scholar]
  3. Bampton P. A., Holloway R. H. A prospective study of the gastroenterological causes of iron deficiency anaemia in a general hospital. Aust N Z J Med. 1996 Dec;26(6):793–799. doi: 10.1111/j.1445-5994.1996.tb00627.x. [DOI] [PubMed] [Google Scholar]
  4. Baumann Kurer S., Seifert B., Michel B., Ruegg R., Fehr J. Prediction of iron deficiency in chronic inflammatory rheumatic disease anaemia. Br J Haematol. 1995 Dec;91(4):820–826. doi: 10.1111/j.1365-2141.1995.tb05395.x. [DOI] [PubMed] [Google Scholar]
  5. Bender G. N., Maglinte D. D., Klöppel V. R., Timmons J. H. CT enteroclysis: a superfluous diagnostic procedure or valuable when investigating small-bowel disease? AJR Am J Roentgenol. 1999 Feb;172(2):373–378. doi: 10.2214/ajr.172.2.9930786. [DOI] [PubMed] [Google Scholar]
  6. Berger M., Brass L. F. Severe thrombocytopenia in iron deficiency anemia. Am J Hematol. 1987 Apr;24(4):425–428. doi: 10.1002/ajh.2830240412. [DOI] [PubMed] [Google Scholar]
  7. Bottaro G., Cataldo F., Rotolo N., Spina M., Corazza G. R. The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases. Am J Gastroenterol. 1999 Mar;94(3):691–696. doi: 10.1111/j.1572-0241.1999.00938.x. [DOI] [PubMed] [Google Scholar]
  8. COLEMAN D. H., STEVENS A. R., Jr, FINCH C. A. The treatment of iron deficiency anemia. Blood. 1955 Jun;10(6):567–581. [PubMed] [Google Scholar]
  9. Chak A., Cooper G. S., Canto M. I., Pollack B. J., Sivak M. V., Jr Enteroscopy for the initial evaluation of iron deficiency. Gastrointest Endosc. 1998 Feb;47(2):144–148. doi: 10.1016/s0016-5107(98)70347-5. [DOI] [PubMed] [Google Scholar]
  10. Cook I. J., Pavli P., Riley J. W., Goulston K. J., Dent O. F. Gastrointestinal investigation of iron deficiency anaemia. Br Med J (Clin Res Ed) 1986 May 24;292(6532):1380–1382. doi: 10.1136/bmj.292.6532.1380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cook J. D. Clinical evaluation of iron deficiency. Semin Hematol. 1982 Jan;19(1):6–18. [PubMed] [Google Scholar]
  12. Dagg J. H., Goldberg A., Gibbs W. N., Anderson J. R. Detection of latent pernicious anaemia in iron-deficiency anaemia. Br Med J. 1966 Sep 10;2(5514):619–621. doi: 10.1136/bmj.2.5514.619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Drüeke T. B., Bárány P., Cazzola M., Eschbach J. W., Grützmacher P., Kaltwasser J. P., Macdougall I. C., Pippard M. J., Shaldon S., van Wyck D. Management of iron deficiency in renal anemia: guidelines for the optimal therapeutic approach in erythropoietin-treated patients. Clin Nephrol. 1997 Jul;48(1):1–8. [PubMed] [Google Scholar]
  14. Fine K. D. The prevalence of occult gastrointestinal bleeding in celiac sprue. N Engl J Med. 1996 May 2;334(18):1163–1167. doi: 10.1056/NEJM199605023341804. [DOI] [PubMed] [Google Scholar]
  15. Fireman Z., Kopelman Y., Sternberg A. Endoscopic evaluation of iron deficiency anemia and follow-up in patients older than age 50. J Clin Gastroenterol. 1998 Jan;26(1):7–10. doi: 10.1097/00004836-199801000-00003. [DOI] [PubMed] [Google Scholar]
  16. GROSS S., KEEFER V., NEWMAN A. J. THE PLATELETS IN IRON-DEFICIENCY ANEMIA. I. THE RESPONSE TO ORAL AND PARENTERAL IRON. Pediatrics. 1964 Sep;34:315–323. [PubMed] [Google Scholar]
  17. Gabay C., Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999 Feb 11;340(6):448–454. doi: 10.1056/NEJM199902113400607. [DOI] [PubMed] [Google Scholar]
  18. Gordon S. R., Smith R. E., Power G. C. The role of endoscopy in the evaluation of iron deficiency anemia in patients over the age of 50. Am J Gastroenterol. 1994 Nov;89(11):1963–1967. [PubMed] [Google Scholar]
  19. Gordon S., Bensen S., Smith R. Long-term follow-up of older patients with iron deficiency anemia after a negative GI evaluation. Am J Gastroenterol. 1996 May;91(5):885–889. [PubMed] [Google Scholar]
  20. Guyatt G. H., Patterson C., Ali M., Singer J., Levine M., Turpie I., Meyer R. Diagnosis of iron-deficiency anemia in the elderly. Am J Med. 1990 Mar;88(3):205–209. doi: 10.1016/0002-9343(90)90143-2. [DOI] [PubMed] [Google Scholar]
  21. Hankey G. L., Holmes G. K. Coeliac disease in the elderly. Gut. 1994 Jan;35(1):65–67. doi: 10.1136/gut.35.1.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hardwick R. H., Armstrong C. P. Synchronous upper and lower gastrointestinal endoscopy is an effective method of investigating iron-deficiency anaemia. Br J Surg. 1997 Dec;84(12):1725–1728. [PubMed] [Google Scholar]
  23. Hsia P. C., al-Kawas F. H. Yield of upper endoscopy in the evaluation of asymptomatic patients with Hemoccult-positive stool after a negative colonoscopy. Am J Gastroenterol. 1992 Nov;87(11):1571–1574. [PubMed] [Google Scholar]
  24. Intragumtornchai T., Rojnukkarin P., Swasdikul D., Israsena S. The role of serum ferritin in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis. J Intern Med. 1998 Mar;243(3):233–241. doi: 10.1046/j.1365-2796.1998.00290.x. [DOI] [PubMed] [Google Scholar]
  25. Izaks G. J., Westendorp R. G., Knook D. L. The definition of anemia in older persons. JAMA. 1999 May 12;281(18):1714–1717. doi: 10.1001/jama.281.18.1714. [DOI] [PubMed] [Google Scholar]
  26. Jolobe O. M. Subnormal serum vitamin B12 concentration. J Am Geriatr Soc. 1997 Sep;45(9):1158–1159. doi: 10.1111/j.1532-5415.1997.tb05993.x. [DOI] [PubMed] [Google Scholar]
  27. Joosten E., Pelemans W., Hiele M., Noyen J., Verhaeghe R., Boogaerts M. A. Prevalence and causes of anaemia in a geriatric hospitalized population. Gerontology. 1992;38(1-2):111–117. doi: 10.1159/000213315. [DOI] [PubMed] [Google Scholar]
  28. Kepczyk T., Kadakia S. C. Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia. Dig Dis Sci. 1995 Jun;40(6):1283–1289. doi: 10.1007/BF02065539. [DOI] [PubMed] [Google Scholar]
  29. Kerlin P., Reiner R., Davies M., Sage R. E., Grant A. K. Iron deficiency anaemia--a prospective study. Aust N Z J Med. 1979 Aug;9(4):402–407. doi: 10.1111/j.1445-5994.1979.tb04167.x. [DOI] [PubMed] [Google Scholar]
  30. Lee J. G., Sahagun G., Oehlke M. A., Lieberman D. A. Serious gastrointestinal pathology found in patients with serum ferritin values < or = 50 ng/ml. Am J Gastroenterol. 1998 May;93(5):772–776. [PubMed] [Google Scholar]
  31. Lindsay D. C., Freeman J. G., Cobden I., Record C. O. Should colonoscopy be the first investigation for colonic disease? Br Med J (Clin Res Ed) 1988 Jan 16;296(6616):167–169. doi: 10.1136/bmj.296.6616.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Lipschitz D. A., Cook J. D., Finch C. A. A clinical evaluation of serum ferritin as an index of iron stores. N Engl J Med. 1974 May 30;290(22):1213–1216. doi: 10.1056/NEJM197405302902201. [DOI] [PubMed] [Google Scholar]
  33. Looker A. C., Dallman P. R., Carroll M. D., Gunter E. W., Johnson C. L. Prevalence of iron deficiency in the United States. JAMA. 1997 Mar 26;277(12):973–976. doi: 10.1001/jama.1997.03540360041028. [DOI] [PubMed] [Google Scholar]
  34. Lucas C. A., Logan E. C., Logan R. F. Audit of the investigation and outcome of iron-deficiency anaemia in one health district. J R Coll Physicians Lond. 1996 Jan-Feb;30(1):33–36. [PMC free article] [PubMed] [Google Scholar]
  35. Maglinte D. T., Reyes B. L. Small bowel cancer. Radiologic diagnosis. Radiol Clin North Am. 1997 Mar;35(2):361–380. [PubMed] [Google Scholar]
  36. McIntyre A. S., Long R. G. Prospective survey of investigations in outpatients referred with iron deficiency anaemia. Gut. 1993 Aug;34(8):1102–1107. doi: 10.1136/gut.34.8.1102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Nilsson-Ehle H., Jagenburg R., Landahl S., Svanborg A., Westin J. Haematological abnormalities and reference intervals in the elderly. A cross-sectional comparative study of three urban Swedish population samples aged 70, 75 and 81 years. Acta Med Scand. 1988;224(6):595–604. [PubMed] [Google Scholar]
  38. Punnonen K., Irjala K., Rajamäki A. Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood. 1997 Feb 1;89(3):1052–1057. [PubMed] [Google Scholar]
  39. Rockey D. C., Cello J. P. Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med. 1993 Dec 2;329(23):1691–1695. doi: 10.1056/NEJM199312023292303. [DOI] [PubMed] [Google Scholar]
  40. Rockey D. C., Koch J., Cello J. P., Sanders L. L., McQuaid K. Relative frequency of upper gastrointestinal and colonic lesions in patients with positive fecal occult-blood tests. N Engl J Med. 1998 Jul 16;339(3):153–159. doi: 10.1056/NEJM199807163390303. [DOI] [PubMed] [Google Scholar]
  41. Sears D. A. Anemia of chronic disease. Med Clin North Am. 1992 May;76(3):567–579. doi: 10.1016/s0025-7125(16)30340-6. [DOI] [PubMed] [Google Scholar]
  42. Wilcox C. M., Alexander L. N., Clark W. S. Prospective evaluation of the gastrointestinal tract in patients with iron deficiency and no systemic or gastrointestinal symptoms or signs. Am J Med. 1997 Nov;103(5):405–409. doi: 10.1016/s0002-9343(97)00168-x. [DOI] [PubMed] [Google Scholar]
  43. Zuckerman G., Benitez J. A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding. Am J Gastroenterol. 1992 Jan;87(1):62–66. [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES