Recognizing and investigating iron-deficiency anemia in hospitalized elderly people

Abstract

Objective: To determine whether anemia is documented and appropriately investigated for iron deficiency in hospitalized elderly people.

Design: Retrospective chart review.

Setting: Medical clinical teaching unit (CTU) in secondary care hospital in Hamilton, Ont.

Participants: Consecutive patients 65 years of age or older admitted between April 1992 and March 1993.

Outcome measures: Proportion of anemic patients for whom documentation was adequate (included in problem list in patient chart) and for whom adequate investigations were performed (measurement of serum ferritin level in anemic patients in whom iron deficiency was suspected, bone-marrow aspiration for those with intermediate probability of iron deficiency after determination of serum ferritin level, and endoscopy of upper or lower gastrointestinal tract, or both, in patients with iron deficiency).

Results: Of 183 eligible patients admitted to the CTU 66 (36%) had anemia, in 47 cases (71%) the anemia was documented by house staff or attending physicians. Of the 66 anemic patients 49 had a non-macrocytic anemia of unknown cause: 26 had their serum ferritin level measured, 5 underwent bone-marrow aspiration, and 21 were referred for gastrointestinal endoscopy. Six of eight patients with probable iron deficiency (i.e., a serum ferritin level that was diagnostic [less than 18 micrograms/L] or suggestive [18 to 45 micrograms/L]) underwent endoscopy, two were found to have cancer of the stomach or cecum. Only 26 of the 49 patients had adequate investigation.

Conclusions: Anemia is common among elderly patients in hospital. However, iron deficiency is underrecognized and underinvestigated.