Haematinics for anaemia in the elderly

  • SB Khoo


It is not uncommon for a Family Physician to come across elderly patients taking inappropriate haematinics on regular basis for many years with the belief that these supplements are essential to maintain good health. In Malaysia, patients are self-referred to general practitioners and private hospital specialists. They often choose who they want to consult; not who they should consult. There is lack of comprehensive and continuity of care by one specific family doctor and haematinics are easily available over the counter without the need of a prescription (copied from article).


Guralnik JM, Eisenstaedt RS, Ferrucci L, et al. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004;104(8):2263-8.

Zablocki E. Some U.S. elderly take unnecessary iron supplements. WebMD Health News. 2001.

Fleming DJ, Jacques PF, Tucker KL, et al. Iron status of the free-living, elderly Framingham Heart Study cohort: an iron-replete population with a high prevalence of elevated iron stores. Am J Clin Nutr. 2001;73(3):638-46.

Muretto P, Angelucci E, Lucarelli G. Reversibility of cirrhosis in patients cured of thalassemia by bone marrow transplantation. Ann Intern Med. 2002;136(9):667-72.

Klipstein-Grobusch K, Koster JF, Grobbee DE, et al. Serum ferritin and risk of myocardial infarction in the elderly: the Rotterdam Study. Am J Clin Nutr. 1999;69(6):1231-6.

Jiang R, Manson JE, Meigs JB, et al. Body iron stores in relation to risk of type 2 diabetes in apparently healthy women. JAMA. 2004;291(6):711-7.

Montgomery EB Jr. Heavy metals and the etiology of Parkinson’s disease and other movement disorders. Toxicology. 1995;97(1-3):3-9.

de Sousa M, Porto G. The immunological system in hemochromatosis. J Hepatol. 1998;28(Suppl 1):1-7.

Herbert V, Shaw S, Jayatilleke E, et al. Most free-radical injury is iron related: it is promoted by iron, hemin, holoferritin and vitamin c, and inhibited by desferoxamine and apoferritin. Stem Cells. 1994;12(3):289-303.

Smith MA, Harris PL, Sayre LM, et al. Iron accumulation in Alzheimer disease is a source of redox-generated free radicals. Proc Natl Acad Sci USA. 1997;94(18):9866-8.

Nelson RL. Iron and colorectal cancer risk: human studies. Nutr Rev. 2001;59(5):140-8.

Salonen JT, et al. The role of iron in diabetes and coronary heart disease. Metals Ions Bio Med. 1998;485-490.

de Valk B, Marx JJ. Iron, atherosclerosis, and ischemic heart disease. Arch Intern Med. 1999;159(14):1542-8.

Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anaemia. Gut. 2000;46:(iv)1-5.

Mukhopadhyay D, Mohanaruban K. Iron deficiency anaemia in older people: investigation, management and treatment. Age Ageing. 2002;31(2):87-91.

Murphy PT, Hutchinson RM. Identification and treatment of anaemia in older patients. Drugs Aging. 1994;4(2):113-27.

Guyatt GH, Oxman AD, Ali M, et al. Laboratory diagnosis of iron-deficiency anaemia: an overview. J Gen Intern Med. 1992;7(2):145-53.

Smith DL. Anemia in the elderly. Am Fam Physician. 2000;62(7):1565-72.

British Columbia Medical Association Guidelines and Protocols Advisory Committee. Iron Deficiency - Investigation and Management. 2010.

Rimon E, Kagansky N, Kagansky M, et al. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Am J Med. 2005;118(10):1142-7.

Linker C A. Blood - Anaemias. In: Current medical diagnosis and treatment. Edited by Tierney LM, McPhee SJ & Papadakis MA. 47th ed. The McGraw Hills Companies Inc USA; 1998. p. 422-37.

Guralnik JM, Ershler WB, Schrier SL, et al. Anemia in the elderly: a public health crisis in hematology. Hematology. 2005.

Savage DG, Lindenbaum J, Stabler SP, et al. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med. 1994; 96(3):239-46.

Andrès E, Goichot B, Schlienger JL. Food cobalamin malabsorption: a usual cause of vitamin B12 deficiency. Arch Intern Med. 2000;160(13):2061-2.

Dawson DW, Gozzard DI, Lewis MJ. Protein-bound vitamin B12 absorption test. J Clin Pathol. 1988;41(4):478-9.

Joosten E, Ghesquiere B, Linthoudt H, et al. Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient. Am J Med. 1999;107(1):24-9.

Nexo E, Hansen M, Rasmussen K, et al. How to diagnose cobalamin deficiency. Scand J Clin Lab Invest Suppl. 1994; 219:61-76.

Stabler SP. Vitamin B12 deficiency in older people: improving diagnosis and preventing disability. J Am Geriatr Soc. 1998;46(10):1317-9.

Turner RA. Haematological aspects. In: Doyle D, Hanks G, Cherny N, editors. 2nd ed. Oxford Textbook of Palliative Medicine. Oxford University Press Inc. New York; 1998. p. 769-76.

Lipschitz DA. The anemia of chronic disease. J Am Geriatr Soc. 1990;38(11):1258-64.

Kis AM, Carnes M. Detecting iron deficiency in anemic patients with concomitant medical problems. J Gen Intern Med. 1998;13(7):455-61.

Weiss G, Goodnough LT. Anaemia of chronic disease. N Engl J Med. 2005;352(10):1011-23.

Davis MP. Hematology in palliative medicine. Am J Hosp Palliat Care. 2004;21(6):445-54.

Rosenzweig MQ, Bender CM, Lucke JP, et al. The decision to prematurely terminate a trial of R-HuEPO due to thrombotic events. J Pain Symptom Manage. 2004;27(2):185-90.

Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoeitin alfa in chronic kidney disease. N Engl J Med. 2006; 355(20):2085-98.

Hirst B. Management of anaemia in palliative care. 2009.

Tanneberger S, Melilli G, Strocchi E, et al. Use of red blood cell transfusion in palliative care services: is it still up to date or is cancer-related anaemia controlled better with erythropoietic agents? Ann Oncol. 2004;15(5):839-40.

Daly MP. Anemia in the elderly. Am Fam Physician. 1989;39(3):129-36.

Joosten E, Pelemans W, Hiele M, et al. Prevalence and causes of anaemia in a geriatric hospitalized population. Gerontology. 1992;38(1-2):111-7.

Kikuchi M, Inagaki T, Shinagawa N. Five-year survival of older people with anemia: variation with hemoglobin concentration. J Am Geriatr Soc. 2001;49(9):1226-8.

How to Cite
KhooS. (2011). Haematinics for anaemia in the elderly. Malaysian Family Physician, 6(1), 8. Retrieved from https://www.e-mfp.org/ojs3/index.php/MFP/article/view/44
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