Intravenous iron in the frail older person with anaemia: Can current biochemical tests utilised in the guidelines on Intravenous iron for heart failure with iron deficiency help predict response ?

Abstract

Anaemia is common in the older person (greater than 65 years) of which anaemia of inflammation and chronic disease is more prevalent than iron deficiency. Biochemical iron parameters on iron status is compromised in the older person as serum ferritin is increased with age and during inflammation whereas, transferrin saturation can be inappropriately depressed. There are no specific guidelines for intravenous iron for the older person with anaemia. However, the European Society of Cardiology has proposed guidelines in heart failure patients who are iron deficient to receive intravenous therapy. These guidelines also utilised ferritin and transferrin saturation. We elected to explore if these could predict haemoglobin response in the older person.

Method; We examined serum ferritin, transferrin saturation, mean corpuscular volume, C-reactive protein and haemoglobin in anaemic older patients before and 4 weeks post infusion.

Results; Response to iron was observed in subjects with a transferrin saturation of less than 20 and a ferritin to 200 µg/L. For those with a ferritin between 201- 299 µg/L, a haemoglobin response was also observed but attenuated. Mixed anaemia was more common than iron deficiency where improvement was also observed. No response was noted with a ferritin of greater than 400 µg/L.

Conclusions; The European Society of Cardiology guidelines on heart failure with iron deficiency may aid to predict response to iron. Mixed anaemia was common where haemoglobin response was less optimal than in the iron deficiency cohort. Clinicians should resist giving therapy based solely on a low transferrin saturation.