What should I do if the elderly are prone to iron deficiency anemia?

elderlycaresystems

elderlycaresystems

Iron deficiency of poor blood is the aging population of the most common is poor blood type type

Iron deficiency of poor blood is the aging population of the most common is poor blood type type

Expert consensus to determine the definition of aging populations at high risk of iron deficiency anemia, consensus following summary from the background, definitions, screening , diagnosis , management , prevention aspect, discussed in detail the treatment of iron deficiency anemia related to aging issues screening diagnostic management prevention

Background background

According to the third National Health and Nutrition Survey (NHANES Ⅲ) in the United States, approximately 3 million elderly people over 65 suffer from anemia.

According to the third National Health and Nutrition Survey (NHANES Ⅲ) in the United States, approximately 3 million elderly people over 65 suffer from anemia.

Definition definition

Elderly iron deficiency anemia high-risk group is defined as 65 years old (including 65 years old) with high-risk factors for iron deficiency anemia, such as long-term vegetarianism, chronic gastric disorders, chronic intestinal diseases, etc.

Elderly iron deficiency anemia high-risk group is defined as 65 years old (including 65 years old) with high-risk factors for iron deficiency anemia, such as long-term vegetarianism, chronic gastric disorders, chronic intestinal diseases, etc.

Screening screening

Symptoms, signs and risk factor screening

Symptoms, signs and risk factor screening

The elderly people often have more diseases, usually with one or more diseases, and some underlying symptoms or signs will cover up the symptoms and signs caused by iron deficiency anemia

The elderly people often have more diseases, usually with one or more diseases, and some underlying symptoms or signs will cover up the symptoms and signs caused by iron deficiency anemia

Elderly people who have been screened for symptoms, signs, and risk factors that are suspicious or have positive results should be persuaded to carry out corresponding laboratory tests

diagnosis

diagnosis

Because iron-deficiency anemia is a progressive and dynamic development process from iron deficiency, iron-deficiency erythropoiesis to iron-deficiency anemia, there are different diagnostic criteria at different stages

Diagnostic criteria for iron deficiency:

Diagnostic criteria for iron deficiency:

The iron deficiency can be diagnosed by meeting any one of the following items

① Serum ferritin (sSF) <14 μg/L

②Bone marrow iron staining showed that the small bone marrow particles could be stained with iron and disappeared

Diagnostic criteria for iron-deficiency erythropoiesis:

Diagnostic criteria for iron-deficiency erythropoiesis:

Meet the diagnostic criteria for iron deficiency, and any one of the following can be diagnosed

①Transferrin saturation is less than 0.

② Free erythrocyte protoporphyrin (FEP)>0.
9 μmo1/L (0.
5 mg/L) (whole blood), or blood zinc protoporphyrin (ZPP)>0.
96 μmo1/L (0.
6 mg/L) (whole blood), Or ZPP>3.
0 μg/g hemoglobin (Hb)
.

③ Bone marrow iron staining showed that the small bone marrow particles could be stained with iron and disappeared, and the iron granulocytes were less than 15%
.

Diagnostic criteria for iron deficiency anemia:

Diagnostic criteria for iron deficiency anemia:

Those who meet any 2 or more of Articles ① and ②-⑨ can be diagnosed as iron deficiency anemia
.

①Small cell hypochromic anemia: male Hb＜120 g/L, female Hb＜110 g/L, pregnant woman Hb＜100 g/L; average red blood cell volume＜80 fl, average red blood cell Hb content＜27 pg, average Hb concentration＜ 0.
32; The morphology of red blood cells may show obvious hypopigmentation
.

②There is a clear cause and clinical manifestations of iron deficiency
.

③ Serum iron <8.
95 μmol/L (0.
5 mg/L), total iron binding capacity>64.
44 μmol/L (3.
6 mg/L)
.

④Transferrin saturation is less than 0.
15
.

⑤ Bone marrow iron staining shows that the small bone marrow particles can be stained with iron and disappear, and the iron granular red blood cells are less than 15%
.

⑥Red blood cell FEP>0.
9 μmol/L (0.
5 mg/L) (whole blood), or blood ZPP>0.
96 μmo1/L (0.
6 mg/L) (whole blood), or ZPP>3.
0 μg/g Hb
.

⑦SF<14 μg/L
.

⑧The concentration of serum soluble transferrin receptor>26.
5 nmol/L (2.
25 mg/L)
.

⑨Iron treatment is effective
.

The SF standards used in the domestic diagnosis of iron deficiency are:

The SF standards used in the domestic diagnosis of iron deficiency are:

SF＜12 μg/L, SF＜16 μg/L or SF＜20 μg/L
.
However, it is generally advocated that SF<12μg/L is used as iron storage depletion, and SF<20 μg/L means iron storage is reduced
.
If infection is considered, it is recommended to combine C-reactive protein (CRP) and α1-acid glycoprotein (AGP) to determine whether it is iron deficiency
.
When CRP≤5 mg/L and AGP≤1 g/L, use SF<25 μg/L as the criterion for iron deficiency; when CRP>5 mg/L or AGP>1 g/L, use SF<32 μg/L is the criterion for iron deficiency; when CRP>5 mg/L and AGP>1 g/L, SF<46 μg/L is the criterion for iron deficiency
.

Infect

Anemia classification standards:

① Mild: Hb 90～110 g/L for females, 90～120 g/L for males
.
② Moderate: Hb 61～90 g/L
.
③Severe: Hb 31～60 g/L
.
④ Extremely severe: Hb<31 g/L
.

Management and prevention

Management and prevention

The management of high-risk groups of iron-deficiency anemia in the elderly can be understood as the comprehensive management of chronic diseases
.
Improving the management system for iron deficiency anemia and its high-risk groups can effectively reduce the occurrence and progression of the disease, prevent or control risk factors, reduce medication, control medical costs, and save social health resources
.

Daily life

The appropriate daily life mainly includes the following aspects: ①The daily life is regular, eating regularly, quitting smoking and drinking, and exercising properly
.
② Correct bad habits such as partial eclipse, vegetarianism, and excessive dieting
.
③Control excessive weight loss and ensure balanced nutrition
.
④ Maintain optimism and build confidence in overcoming the disease
.

Diet care

It mainly includes the following aspects: ①Enough food intake to ensure the intake of soybean products and dairy products
.
② Increase the intake of lean meat, poultry, fish, animal liver and animal blood appropriately
.
③ Increase the intake of vegetables and fruits
.
④ It is not advisable to drink strong tea or coffee before and within 1 h after meals
.
⑤ Encourage the elderly with insufficient dietary intake or malnutrition to use iron, folic acid, vitamin

Supplements and fortified foods of B12
.

Prevent insufficient iron intake

The elderly have different degrees of decline in organ function and are affected by chronic diseases, comorbidities and multi-drug use, coupled with reduced living or activity capacity, they are prone to insufficient intake of early saturated food, resulting in malnutrition, anemia and other problems
.
On the basis of classic syndrome differentiation, treatment and prescriptions, the hematopoietic substances that are beneficial to blood metaplasia recorded in ancient books can be appropriately supplemented, such as vanadium soap (green alum), acupuncture sand, bile alum, ochre, magnet, etc.
The pig iron falls and waits to avoid iron deficiency
.

Prevent iron malabsorption

After subtotal gastrectomy and gastrojejunostomy, chronic diarrhea, atrophic gastritis, achlorhydria, and long-term drinking of strong tea or coffee can all affect iron malabsorption
.

Prevent excessive iron loss

Hemorrhoids bleeding, ulcer bleeding, hiatal hernia rupture, colitis bleeding, multiple excessive blood donations, bleeding caused by taking aspirin or other drugs, surgical bleeding, acute trauma bleeding, etc.
can all lead to excessive iron loss
.

Chinese patent medicine prevention

It is best to choose Chinese patent medicines that are clearly marked in the instructions as having the indications for the treatment of iron-deficiency anemia, or for improving the symptoms of anemia, or containing hematopoietic substances that are conducive to blood metaplasia, such as Yizhong Shengxue Capsules (tablets), peach Qi Shengxue Capsules, Shengxue Ning Tablets, Shengxuebao Mixture (granules), Jianpi Shengxue Granules, Zaishengxue Capsules (tablets), Compound Ejiao Pu, Xuesusheng Granules, Yiqi Weixue Capsules (granules, tablets, containing pig blood extract) It can play a good preventive effect
.

treatment

treatment

Effective treatment can not only cure the disease, but also prevent the recurrence of the disease
.
The following different methods can be used for treatment
.

Chinese medicine decoction treatment

Taking decoction based on syndrome differentiation is a classic method for the treatment of iron deficiency anemia
.
It can be treated according to the corresponding syndrome types
.
①Spleen and stomach weakness: It is advisable to invigorate the spleen and stomach, and choose Xiangsha Liujunzi Decoction ("Shi Fang Ge Kuo") to add flavor
.
② Syndrome of deficiency of both heart and spleen: It is advisable to replenish the heart and spleen, and choose Guipi Decoction ("Jishengfang") addition and subtraction
.
③Spleen and kidney deficiency syndrome: It is advisable to invigorate the spleen and kidney, choose Yigongsan ("Pediatric Medicine Straight Jue") and Liuwei Dihuang Pills
.

Chinese patent medicine treatment

Proprietary Chinese medicines, especially those with indications for the treatment of iron-deficiency anemia in the instructions, have evidence-based medicine.
They are convenient to take and are more suitable for application in community medical and health stations
.
At present, many researches and applications are Shengxuebao Mixture, Yiqiweixue Capsules (granules, tablets), Yizhongshengxue Capsules (tablets), compound donkey-hide gelatin and Jianpi Shengxue granules
.
When using the above-mentioned Chinese patent medicines, it is also necessary to use the principles of TCM syndrome differentiation and treatment, according to the functions and indications specified in the instructions, combined with the patient's clinical syndromes to choose and apply, in order to obtain the dual effect of treating diseases and improving symptoms
.

Reference materials:

Reference materials:

Luo Meihong,Cui Lele,Sun Weizheng,Chen Xinyi.
Expert consensus on prevention and treatment of traditional Chinese medicine in communities at high risk of iron deficiency anemia in the elderly[J].
Modern Chinese Medicine Clinic,2021,28(04):29-35.

Luo Meihong,Cui Lele,Sun Weizheng,Chen Xinyi.
Expert consensus on prevention and treatment of traditional Chinese medicine in communities at high risk of iron-deficiency anemia in the elderly[J].
Modern Chinese Medicine Clinic,2021,28(04):29-35.


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