Iron is the main component of hemoglobin which plays an essential role in oxygen transport by red blood cells, and therefore, the lack of a physiological amount of iron affects the oxygen-carrying capacity of the blood, leading to tissue hypoxia (deprivation of oxygen supply) [2]. 

What Are the Causes of Iron Deficiency Anemia in the Elderly?

Any disorder, condition, diet, or medication that limits the supply or absorption of iron will restrict the amount of hemoglobin available to transport oxygen; thus, leading to iron deficiency anemia.

1- Stomach ulcers

Stomach ulcers are associated with damages of the mucus layer that makes the lining of the stomach by the stomach own digestive acidic juices. The results of these damages are a reduction in iron absorption and gastrointestinal bleedings that lead to iron loss and reduction in the body’s iron reserves.

The damages are caused by the excessive use of non-steroidal anti-inflammatory drugs (NSAIDs) and the bacterium Helicobacter Pylori.

Helicobacter Pylori lives in the mucus layer of the stomach where it secretes proteins, toxins, and an enzyme named urease. The proteins are responsible for the inflammation of the mucus layer, while urease transforms the stomach urea into ammonia that neutralizes the digestive acidic juices [3].

The effect of excessive use of non-steroidal anti-inflammatory drugs (NSAIDs) is reported below.

2- Stomach Cancer

Stomach cancer or gastric carcinoma is cancer that develops from the lining of the stomach and which symptoms are associated with a loss of appetite, weight loss, heartburn, indigestion, abdominal pain, and blood loss through blood vomiting and blood in the stool.

It can be caused by Epstein-Barr virus infection, genetics, diet, and inflammation related to Helicobacter Pylori infection [4]. The loss of appetite and the bleeding result in significant losses in iron and iron reserves leading to iron loss and reduction in the body’s iron reserves.

3- Bowel Cancer (Colorectal Cancer)

This cancer develops in the colon or rectum and is associated with a loss of appetite, weight loss, constipation, nausea or vomiting, and rectal bleeding. While a small percentage is due to genetic factors, most bowel cancers are due to aging, and lifestyles [5].

Like stomach cancer, the loss of appetite and rectal bleeding result in significant losses in iron and iron reserves leading to iron loss and reduction in the body’s iron reserves.

4- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs such as Aspirin and Ibuprofen (Advil®) perform their anti-inflammatory action by inhibiting the enzymes cyclooxygenase/prostaglandin-endoperoxide synthase (PGHS-1 and PGHS-2), involved in the biosynthesis of the pro-inflammatory prostaglandin.

However, PGHS-1 is involved in the protection of the gastric mucosa and its excessive inhibition by NSAIDs results in a thinner mucus layer and stomach ulcer [6].

5- Diet

Although the impact of iron dietary deficiency is less frequent in western countries, the lack of iron supply through food consumption can significantly reduce the body’s iron reserves resulting in iron deficiency anemia; however, a diet rich in iron can reverse this disorder.

How Is Iron Deficiency Anemia diagnosed?

The symptoms depend on the speed of onset of anemia, its severity, and the characteristics of the patient, but they generally include the following symptoms [7]:

• Pale complexion
• General weakness and fatigue
• Shortness of breath
• Heart palpitations
• Difficulty swallowing
• Irritability
• Poor concentration
• Headache
• Intolerance to exercise. 

Although the symptoms would indicate a potential iron dietary deficiency, the diagnosis is confirmed by routine blood tests that measure the levels of serum iron, ferritin, and transferrin saturation levels [8].

How Is Iron Deficiency Anemia Treated?

The treatment of iron deficiency relies on iron supplements that can be obtained from rich-iron food such as dark-green leafy vegetables, nuts and seeds, meat, fish, tofu, eggs, brown rice, and dried fruit.

However, medications in a form of tablets or liquid preparations such as Ferrous sulfate, ferrous gluconate, and ferrous fumarate can also be recommended by the doctor. Supplementation with ascorbic acid (Vitamin C) can enhance iron absorption.

A follow-up through measuring the hemoglobin concentration and red cell indices at intervals is also performed for monitoring to ensure recovery. In this case, the hemoglobin concentration should rise by 2 g/dl after 3–4 weeks [9].

Conclusion

Iron dietary deficiency anemia in elderly individuals can be associated with an iron unbalanced diet that is restored  by adequate supplementation with iron-rich food; however, in some cases, it is due to much complex disorders or diseases that require more specific treatments

References

[1] Anía, B.J., Suman, V.J., Fairbanks, V.F., Rademacher, D.M. and III, L.J.M., 1997. Incidence of anemia in older people: an epidemiologic study in a well defined population. Journal of the American Geriatrics Society, 45(7), pp.825-831.

[2] Chaudhry, H.S. and Kasarla, M.R., 2017. Microcytic hypochromic anemia.

[3] Blaser, M.J., 1996. The bacteria behind ulcers. Scientific American, 274(2), pp.104-107.

[4] Brenner, H., Rothenbacher, D. and Arndt, V., 2009. Epidemiology of stomach cancer. Cancer epidemiology, pp.467-477.

[5] Boyle, T., Keegel, T., Bull, F., Heyworth, J. and Fritschi, L., 2012. Physical activity and risks of proximal and distal colon cancers: a systematic review and meta-analysis. Journal of the national cancer institute, 104(20), pp.1548-1561.

[6] Bindu, S., Mazumder, S. and Bandyopadhyay, U., 2020. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochemical pharmacology, p.114147.

[7] Bermejo, F. and García-López, S., 2009. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World journal of gastroenterology: WJG, 15(37), p.4638.

[8] Rimon, E., Levy, S., Sapir, A., Gelzer, G., Peled, R., Ergas, D. and Sthoeger, Z.M., 2002. Diagnosis of iron deficiency anemia in the elderly by transferrin receptor–ferritin index. Archives of internal medicine, 162(4), pp.445-449.[9] Goddard, A.F., McIntyre, A.S. and Scott, B.B., 2000. Guidelines for the management of iron deficiency anaemia. Gut, 46(suppl 4), pp.iv1-iv5.

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