Etiologies of Anemia

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Etiologies of Anemia - #39

Take Quiz

Identify and define various etiologies of anemia in older adults.

Assessment

Definitions of Anemia

  • WHO criteria for anemia:
    • Women Hgb < 12 g/dL
    • Men Hgb < 13 g/dL
  • Of note, hemoglobin levels do not decrease with aging alone. Anemia, while relatively common in older adults, is NOT a normal physiologic result of aging alone.

Impact of anemia in the older adult

  • Increased frailty, decreased exercise performance, diminished cognitive function, increased risk of developing dementia, decreased mobility, increased risk of recurrent falls, lower bone and skeletal muscle density, increased rate of major depression.
  • Increased hospitalizations and length of hospital stays.
  • Increased all-cause mortality.

Evaluation of Anemia

  • History and physical examination
  • Generalized laboratory testing
    • Complete blood count, iron studies (serum iron, transferrin saturation, ferritin), vitamin B12, folate, TSH, erythropoietin level, and renal function
  • Blood smear review
  • Directed evaluation
    • GI evaluation (e.g. endoscopy)
    • Bone marrow evaluation

Context

Elderly patients in the outpatient or inpatient setting with chronic anemia.

Action

List most common etiologies and evaluation of anemia in the elderly.

Incidence / Prevalence

The incidence and prevalence of anemia increases with age. Its prevalence is higher among institutionalized than community-dwelling older adults; is higher in African Americans compared to Caucasians and is higher among men than in women over 65 years of age. More than half of the cases of anemia in older individuals have etiology that could be recognized and treated. According to the NHANES-III (National Health and Nutrition Examination Survey) demonstrated certain etiologies more frequently seen in older adults: Anemia of chronic inflammation (ACI) 33.6%, unknown etiology 24%, iron deficiency 16%, B12 and folate deficiency 14.3%, and renal insufficiency 12%.

Underlying Sciences

Hemoglobin is an iron-containing oxygen transport protein in red blood cells. When iron is deficient, the oxygen carrying capacity is reduced. Vitamin B12 and folate are necessary for the synthesis of DNA. As red blood cells are rapidly turning over, they are especially susceptible to decreases in vitamin B12 and folate. During chronic inflammation, the liver produces increased levels of hepcidin, which indirectly prevents the release of iron from storage. This causes anemia of chronic inflammation, as mentioned above. Finally, chronic kidney disease causes anemia due to a decreased production of erythropoietin, a hormone that drives red blood cell precursor differentiation.

Objectives

• Define the nomenclature for various levels of anemia in elderly patients.
• Outline a basic evaluation for anemia in elderly patients.

 

Keywords/Tags

ACGME Compentencies

Medical Knowledge
Patient Care

References

  1. Guralnik JM, Eisenstaedt RS, Ferrucci L, et al. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004; 104:2263-2268.
  2. Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol. 2012; 19:133-140.
  3. Price EA, Mehra R, Holmes TH, Schrier SL. Anemia in older persons: etiology and evaluation. Blood Cells, Molecules, and Disease. 2011; 46:159-165.
  4. Steensma DP, Tefferi A. Anemia in the elderly: how should we define it, when does it mater, and what can be done? Mayo Clin Proc. 2007; 82(8): 958-966.
  5. Pennix BW, Pahor M, Woodman RC, Guralnick JM. Anemia in old age is associated with increased mortality and hospitalization. Biol Sci Med Sci. 2005; 60:474-479.
This GFF ___ my competence in geriatrics.

Authors

Nicholas Dreger, Thomas Giever DO, Patrick Foy MD, Gabriel Manzi MD, Kathryn Denson MD

Author Affiliation

Medical College of Wisconsin, Milwaukee, Wisconsin

Copyright

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