Clinical research study
Are we giving too much iron? Low-dose iron therapy is effective in octogenarians

https://doi.org/10.1016/j.amjmed.2005.01.065Get rights and content

Abstract

Purpose

Elderly patients are vulnerable to the dose-dependent adverse effects of iron replacement therapy. Our study examines whether low-dose iron therapy can efficiently resolve iron-deficiency anemia in patients over the age of 80 years and reduce adverse effects.

Subjects and methods

Ninety hospitalized patients with iron-deficiency anemia were randomized to receive elemental iron in daily doses of 15 mg or 50 mg as liquid ferrous gluconate or 150 mg of ferrous calcium citrate tablets for 60 days. Thirty control patients without anemia were given 15 mg of iron for 60 days. A 2-hour iron absorption test was performed after the initial dose. Hemoglobin and ferritin levels were measured on day 1, 30, and 60 after initiating therapy. Each patient completed a weekly questionnaire regarding drug-induced adverse effects.

Results

Serum iron rose significantly in the anemic patients beginning 15 minutes after the first dose but not in nonanemic patients. Two months of iron treatment significantly increased hemoglobin and ferritin concentrations similarly in all 3 groups of iron-deficiency anemia patients (for example, hemoglobin levels rose from 10.0 g/dL to 11.3 g/dL with 15 mg/d of iron therapy and from 10.2 g/dL to 11.6 g/dL with 150 mg/d). Abdominal discomfort, nausea, vomiting, changes in bowel movements, and black stools were significantly more common at higher iron doses.

Conclusions

Low-dose iron treatment is effective in elderly patients with iron-deficiency anemia. It can replace the commonly used higher doses and can significantly reduce adverse effects.

Section snippets

Sample

All consecutive admissions to the Acute Geriatric Ward of Kaplan-Harzfeld Medical Center between March, 2001, and February, 2004, were examined for hemoglobin and ferritin levels. Patients were enrolled in the study if they had hemoglobin levels between 80 g/dL and 119 g/dL and ferritin levels below 40 ng/mL. Patients who were unable or unwilling to sign an informed consent, or who had vitamin B12 deficiency, severe systemic illness, underlying malignancy, considerable renal failure (creatinine

Results

Of 5329 admitted patients, 548 patients over the age of 80 years were admitted with a diagnosis of anemia during the 3-year study period. Of these 548 patients, 458 were excluded from the study: 217 with ferritin levels above 40 ng/mL, 30 were unable or unwilling to sign an informed consent, 61 had iron therapy before hospitalization, 53 had vitamin B12 deficiency, and 32 had received recent blood transfusions. Another 19 patients were excluded because of severe systemic illness, 17 because of

Discussion

This study demonstrates that a low iron dose is an effective therapeutic option in elderly patients with iron-deficiency anemia. The lowest dose of elemental iron used was 15 mg, which is considerably lower than the 150 mg found in one tablet of ferrous fumarate, the 65 mg found in one 200-mg tablet of ferrous sulphate, or even the 35 mg found in one 300-mg tablet of ferrous gluconate. Even in elderly patients who have iron deficiency, iron absorption was very fast and efficient. By comparison,

Acknowledgment

The authors thank Lutzy Cojocaru, PhD, of the Ashkelon Academic College for statistical analysis of this work.

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    Owing to the demonstrated effectiveness of oral iron therapy, and the lower cost and ease of administration for both the patient and the health care system, most blood management strategies recommend oral iron supplementation as first-line treatment for patients with IDA with no contraindications.15,51,53,67 Although many dosages have been found to be effective, there is evidence to suggest that lower dosages (e.g., elemental iron equivalent of 40–60 mg orally daily or 80–100 mg orally every 2 d) are associated with fewer adverse effects such as abdominal discomfort, nausea, vomiting and changes in bowel habits.51,63,68 A recent summary of evidence regarding the safety of oral iron supplementation did not identify any major safety concerns, although adverse effects such as nausea, heartburn, pain, and constipation or diarrhea are more common with oral formulations than with intravenous iron infusions.69

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