Anaemia: iron-deficiency: investigations in elderly patients helped management

Clinical bottom line (level 4)

  1. A cause of iron-deficiency anaemia was found in two-thirds of elderly patients.
  2. 40% of patients who were investigated had a change in management.
Ward et al: Age and Ageing 1990; 19: 204-206
Expires October 2002

The study

Inception cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: department of geriatrics, acute hospital, UK

50 patients (aged 66 to 89; mean 76, 70% female) with iron-deficiency anaemia: defined as Hb < 110 g/l, MCV < 80fl, and one of
  • serum iron < 10 micromol/l and total iron-binding capacity > 75%
  • serum ferritin < 20 g/l in women, < 30 g/l in men
  • rise in Hb > 20 g/l if started on iron supplements


Excluded if
  • known cause for blood loss
  • overt GI bleed
  • fully assessed for iron deficiency within previous year
  • general debility


All patients had a history and physical. 92% had a gastroscopy and 84% had a rigid sigmoidoscopy and double-contrast barium enema.

?100% followed for length of hospital stay
Outcomes studied:
  • cause found
  • management considered to be altered , cancer or adenoma found, specific therapy started or further investigations performed
 

The evidence

outcome time to outcome number of patients/total number %
(95% CI)
cause found length of hospital stay 34/50 68%
(55% to 80%)
management considered to be altered length of hospital stay 22/50 44%
(30% to 59%)

Comments

  1. 40% of cases were due to peptic ulcer disease or erosions. 16% of cases were due to malignancy.

Citation

  1. Ward MC, Gundroo D, Bailey RJ, et al: Effect of investigation on the management of elderly patients with iron deficiency anaemia. Age and Ageing 1990; 19: 204-206
Search Terms:
Contributor: Chris Ball and Clare Wotton, October 1999
Reviewer: Santiago Alvarez Montero

Clinical Question.
Patient elderly patients with iron-deficiency anaemia
Intervention or Exposure investigations
Outcome cause found, change in management