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Part II Nutrition Assessment, Consequences, and Implications

TABLE 11.4 Laboratory Test Results for Iron-Deficiency Anemia

Laboratory Test

Hemoglobin (g/dL) Hematocrit (%)

Mean corpuscular volume (mm3)

Mean corpuscular hemoglobin (pg/cell)

Mean corpuscular

hemoglobin concentration (g/dL)

Serum iron (mg/dL) Ferritin (ng/mL) Transferrin

Total iron binding capacity (mg/dL)

↓ ↓ ↓ ↑

elemental iron daily is preferred; however, other options include administering iron parenterally as an iron-carbohydrate complex or as a blood transfusion (3). Liquid iron supplements should be avoided if pos- sible because of the potential to cause discoloration of the teeth. In many cases a multivitamin may be better tolerated. Absorption is best on an empty stomach or at least one hour before meals and in combination with vitamin C supplementation or high–vitamin C contain- ing foods (12,13,17). The goal of pharmacological intervention is to increase the deficient body compo- nents while avoiding a negative impact on the total dietary intake of the older adult. Side effects of iron therapy include metallic taste, heartburn, nausea, and constipation or diarrhea.

Anemia of Chronic Disease/ Inflammation

Anemia of chronic disease/inflammation manifests simi- larly to iron-deficiency anemia. It is often associated with a chronic infection or inflammation, congestive heart failure, and other chronic diseases. The anemia may present up to 4 to 6 weeks after illness due to a chronic

Iron Deficiency Microcytic ↓ ↓ ↓

↓ ↓

infection or inflammation. The anemia is caused by a decrease in erythropoietin, which decreases RBC produc- tion and impairs iron delivery from the reticuloendothelial system to the bone marrow (4).

Although the physical signs and symptoms are the same, anemia of chronic disease is a normochromic-normocytic anemia seen in older adults and in those with AIDS and Crohn’s disease. Hemoglobin, hematocrit, serum iron, and TIBC will all be below normal range. However, the MCV and ferri- tin level will be normal (5). Table 11.5 lists the pattern of laboratory values typi- cally seen in anemia of chronic disease. This pattern of test results suggests that the body is unable to absorb and use iron from food and mineral supplements. A multivitamin supplement with iron or oral iron therapy may be ordered but should be carefully moni- tored for expected outcomes, especially in those who have a high or normal ferritin level (above 100 ng/mL) because of possible adverse outcomes (3). In cases of true anemia of chronic disease, the body will not be able to absorb these additional nutrients; therefore, no significant improvement will be observed. In this case,

TABLE 11.5 Laboratory Test Results for Anemia of Chronic Disease

Laboratory Test

Hemoglobin (g/dL) Hematocrit (%)

Mean corpuscular volume (mm3)

Mean corpuscular hemoglobin (pg/cell)

Mean corpuscular hemoglobin

concentration (g/dL) Serum iron (mg/dL) Ferritin (ng/mL) Transferrin

Total iron binding capacity (mg/dL)

Anemia of Chronic Disease

Normocytic ↓ ↓

↔ ↓ ↓ / ↔ ↓

↑ / ↔ — ↓