Gordon S, Bensen S, Smith R
Department of Gastroenterology, VA Medical Center, White River Junction, Vermont, USA.
Am J Gastroenterol. 1996 May;91(5):885-9.
To determine the clinical outcome of a cohort of patients over the age of 50 yr with iron deficiency anemia in whom a source was not identified during a prior GI evaluation.
A cohort of 69 patients (43 men, 26 women) with a mean age of 68 yr (range 50-89 yr) who previously had a negative GI evaluation for documented iron deficiency anemia was followed for an average of 39 months (range 2-89 months).
In 49 patients (71%), the iron deficiency anemia resolved. All remained stable during the follow-up period except five patients in whom iron deficiency recurred (from 18 months to 5 yr later). Subsequent GI evaluations were negative, and iron deficiency resolved with iron supplementation in all five patients. In 16 patients (23%), a mild chronic anemia persisted during the follow-up period. None of these patients required transfusions, and 12 of the 16 had concomitant medical illnesses that likely contributed to an anemia of chronic disease. Only four patients (6%) had a persistent anemia severe enough to require intermittent transfusions. However, in three of these patients, the anemia was likely secondary to chronic disease (chronic renal failure in two patients, metastatic carcinoma in one patient). Therefore, only one patient (1%) had consistent iron deficiency anemia severe enough to require intermittent transfusions, which was found to be secondary to duodenal angiodysplasia during a subsequent GI evaluation.
The prognosis of iron deficiency anemia in older patients after a negative GI evaluation is favorable. The anemia resolves and remains stable in the majority of patients after iron replacement. Subsequent GI evaluations should be reserved for those patients whose anemia is refractory to iron replacement and in whom there are not concomitant medical illnesses contributing to an anemia of chronic disease.
确定一组年龄超过50岁的缺铁性贫血患者的临床结局，这些患者在之前的胃肠道评估中未找到病因。
对69例患者（43例男性，26例女性）进行队列研究，平均年龄68岁（范围50 - 89岁），这些患者之前因缺铁性贫血接受胃肠道评估结果为阴性，随访平均39个月（范围2 - 89个月）。
49例患者（71%）缺铁性贫血得到缓解。除5例患者（18个月至5年后缺铁复发）外，所有患者在随访期间病情保持稳定。随后的胃肠道评估结果为阴性，这5例患者通过补充铁剂后缺铁情况得到缓解。16例患者（23%）在随访期间持续存在轻度慢性贫血。这些患者均无需输血，16例中有12例伴有可能导致慢性病贫血的内科疾病。只有4例患者（6%）贫血严重到需要间歇性输血。然而，其中3例患者的贫血可能继发于慢性病（2例为慢性肾衰竭，1例为转移性癌）。因此，只有1例患者（1%）存在持续的严重缺铁性贫血，需要间歇性输血，后续胃肠道评估发现其病因是十二指肠血管发育异常。
胃肠道评估结果为阴性的老年缺铁性贫血患者预后良好。大多数患者在补充铁剂后贫血得到缓解且保持稳定。后续的胃肠道评估应仅针对那些缺铁性贫血对铁剂治疗无效且不存在导致慢性病贫血的内科疾病的患者。
