If the ferritin test shows low iron levels, one question to examine is poor absorption, which may be a result of other health conditions. For example, the body needs acid to absorb iron, so people who take acid reflux medicine for years can end up with iron deficiency. In addition, people who have had weight loss surgery are also no longer able to absorb iron efficiently.
Another common scenario is blood loss in the gastrointestinal tract, which sometimes can be detected with a colonoscopy or an upper endoscopy. “A patient may not even notice blood in their stool, but a small amount of bleeding every day can lead to anemia,” says Dr. Eisenberger. “Whenever I see somebody over the age of 45, the first thing I ask is whether they’ve had a colonoscopy. In most cases, iron deficiency anemia is not from colon cancer. There are lots of places where you can lose blood from your gastrointestinal tract as you get older, so don’t panic.”
Through rare, bleeding related to cervical or uterine cancer could also lead to iron deficiency in postmenopausal women.
The symptoms of iron deficiency among older adults include fatigue and dizziness; pica (craving substances with no nutritional value, such as ice, dirt, or uncooked rice); leg cramps or restless leg syndrome at night; and mild hair loss.
While the most readily available and inexpensive treatment is an iron supplement, pills can cause bloating, nausea, and constipation. “I tell my patients to take iron pills once a day, three days a week at first, and then if they tolerate it, I have them take it daily,” says Dr. Eisenberger. “Taking iron three times a day is going to cause more side effects and doesn’t really improve iron absorption at all.”
For those who cannot tolerate iron supplements, another option is intravenous iron, which does not have the gastrointestinal side effects. An infusion of iron is given one or two times a year to get the blood counts back up to normal.
“A lot of people we see with iron deficiency have known it for a long time and they know it makes them feel terrible and exhausted, but they cannot tolerate iron pills,” says Dr. Eisenberger. “It’s important to see a hematologist, because iron deficiency is very easy to fix, and it really will tremendously improve your quality of life.”