Low-dose iron supplementation was effective in older patients with iron-deficiency anemia.

M e t h o d s Design: Randomized controlled trial. Allocation: Unclear allocation concealment.* Blinding: Unblinded.* Follow-up period: 60 days. Setting: A geriatric ward in a hospital in Rehovot, Israel. Patients: 90 patients ≥ 80 years of age (mean age 85 y, 59% women) who were admitted to hospital with a diagnosis of anemia (hemoglobin level 80 to 119 g/L [5.0 to 7.4 mmol/L]) and ferritin levels < 40 ng/mL. Exclusion criteria were vitamin B12 deficiency, severe systemic illness, cancer, renal failure, iron therapy or blood transfusion within the previous week, celiac disease, active known gastrointestinal blood loss, or acute infection. Intervention: Elemental iron, 15 mg (n = 30), 50 mg (n = 30), or 150 mg (n = 30) per day. Low iron doses (15 and 50 mg) were given as liquid ferrous gluconate in a simple syrup. The conventional iron dose (150 mg) was given as 1 tablet of 500 mg of ferrous calcium citrate taken 3 times/d. Outcomes: Change from baseline in hemoglobin and ferritin levels and adverse effects. Patient follow-up: 75 patients (83%) completed the study. M a i n r e s u l t s Serum hemoglobin and ferritin levels increased in all 3 groups, with no differences in increase among them (Table 1). Patients who received 150 mg of daily iron had a greater rate of all adverse effects than patients who received 15 mg (Table 2) and a greater rate of nausea and vomiting and black stools than patients who received 50 mg (P < 0.05). Abdominal discomfort, diarrhea, constipation, darkened stools, and black stools were more common in the 50-mg group than in the 15-mg group (P < 0.05). C o n c l u s i o n s In older patients with iron-deficiency anemia, increases in hemoglobin levels did not differ between those receiving low-dose (15 or 50 mg/d) and conventional-dose (150 mg/d) iron supplementation. The lowest dose was associated with fewest adverse effects.