Anemia in elderly patients: New insight into an old disorder

Abstract

Anemia is an important healthcare concern among the elderly. In these patients, the anemia is often mild, with a hemoglobin level >10 g/dL. It is usually well tolerated, but might be responsible for several proteiform and/or atypical presenting complaints. In the elderly, anemia is usually of multifactorial origin, including chronic inflammation, chronic kidney disease, nutrient deficiencies and iron deficiency (approximately two-thirds of all cases). The remaining cases are unexplained (unknown etiology). In the elderly, the classic diagnosis of anemia, which is based on the mean corpuscular volume associated with a low hemoglobin level, might not be accurate. A predefined standardized diagnostic procedure should be followed. In the common case of frail elderly patients, all investigations should be carefully considered and invasive examinations undertaken where justified (risk-benefit balance). Nevertheless, most cases of anemia require further investigation and the underlying cause should be identified and treated whenever possible.

MtDNA mutagenesis impairs elimination of mitochondria during erythroid maturation leading to enhanced erythrocyte destruction

“…Furthermore, the decreased erythroid colony forming potential of Mutator HSCs, combined with a severe maturation delay, is also typical for HSCs extracted from aged people 47 . Anaemia is an important class of human disorders affecting over 50% of 80-year-olds in the population 48 , but only 30% of agingrelated anaemia can be explained by iron deficiency 49 . Since mtDNA mutations accumulate in normal aging humans 50 this raises the question whether aging-related anaemia in human population might also have mitochondrial contribution.…”

Diagnostics in anaemia of chronic disease in general practice: a real-world retrospective cohort study

“…However, GPs may have considered these patients too vulnerable for extensive tests due to, for example, advanced age and/or comorbidities, or the lack of consequences in these frail patients. 24 Comparable studies analysing the underlying causes of ACD have investigated hospitalised populations, whereas no data are available for community-dwelling adults with ACD. In this study, the most common underlying causes of ACD were infections, autoimmune inflammation, and malignancies; this is in line with data from hospitalised patients with ACD.…”

Nutritional Anemia in Elderly Patients of Developed Countries

“…In clinical practice, an Hb level <10 g/dL is often considered to be a cut of level where investigation in the elderly ("anemia to explore"), and treatment should be performed [7]. Indeed, at this Hb level, several recent studies have shown a beneit from investigating the anemia and for treating, in regard to the frequency of discovery of a curable etiology [7].…”

“…Indeed, at this Hb level, several recent studies have shown a beneit from investigating the anemia and for treating, in regard to the frequency of discovery of a curable etiology [7].…”

“…Thus, according to the literatures and in our own experience, the etiology of anemia can be identiied in only approximately 80% of the cases, in spite of the use of new tools such as video capsule [7,14]. Moreover, a signiicant proportion of elderly anemic patients, around 30-50%, are presumed to have multiple causes for their anemia [14,15].…”