Department of Geriatric Medicine, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, the Netherlands.
J Am Geriatr Soc. 2013 Apr;61(4):495-501. doi: 10.1111/jgs.12168. Epub 2013 Mar 21.
To evaluate current clinical practice for octogenarians with iron-deficiency anemia (IDA) by assessing referral patterns, diagnostic choices, clinical consequences of omission of endoscopy, and risks and benefits of IDA-related surgery.
Chart review.
A regional hospital-based laboratory in the Netherlands between January 2008 and December 2010.
All individuals aged 80 and older with newly ascertained IDA.
IDA was defined as a hemoglobin level of 11.1 g/dL or less and a ferritin level of 25 μg/L or less.
Four hundred seventy-one participants were newly diagnosed with IDA during the study period (median age 85.4), 276 of whom (59%) did not undergo any diagnostic procedures for IDA. A cause of anemia was identified during the initial examination in 50% of the 205 investigated participants, including nine (4%) upper and 37 (18%) lower gastrointestinal malignancies. Another 24 malignancies were identified during follow-up, of which 16 were in the gastrointestinal tract, primarily in participants for whom the initial diagnostic examination was limited or omitted. Perioperative mortality was 15% in individuals with colon cancer. Median survival for participants with colon cancer was 2.2 years, and the survival benefit of surgery over supportive care was not apparent until 1.3 years after ascertainment of IDA.
The omission of endoscopy for IDA and the omission of surgery for colon cancer occur frequently in octogenarians and seem appropriate in the presence of significant comorbidity and in cases in which there is limited life expectancy. Further research is needed to determine which baseline factors should guide decision-making to optimize treatment outcomes and quality of life.
通过评估转诊模式、诊断选择、内镜检查遗漏的临床后果以及与缺铁性贫血 (IDA) 相关的手术风险和获益，评估 80 岁以上老年人缺铁性贫血的临床实践现状。
病历回顾。
荷兰一家区域性医院的实验室，时间为 2008 年 1 月至 2010 年 12 月。
所有新确诊为 IDA 的 80 岁及以上个体。
IDA 的定义为血红蛋白水平<11.1 g/dL 和铁蛋白水平<25μg/L。
研究期间共有 471 例患者新诊断为 IDA（中位年龄 85.4 岁），其中 276 例（59%）未接受任何 IDA 诊断程序。在 205 例接受检查的患者中，50%在初次检查时确定了贫血原因，包括 9 例（4%）上消化道和 37 例（18%）下消化道恶性肿瘤。在随访期间又发现了 24 例恶性肿瘤，其中 16 例在胃肠道，主要发生在初始诊断检查受限或遗漏的患者中。结肠癌患者的围手术期死亡率为 15%。结肠癌患者的中位生存时间为 2.2 年，在确诊 IDA 1.3 年后，手术相对于支持性治疗的生存获益才显现出来。
80 岁以上老年人经常会遗漏 IDA 的内镜检查和结肠癌的手术治疗，在存在严重合并症和预期寿命有限的情况下，这种做法似乎是合理的。需要进一步研究来确定哪些基线因素应指导决策，以优化治疗结果和生活质量。
