Clinical and hematological evaluation of geriatric anemia

Abstract

Background: Anemia in the elderly is a cause of concern. It is not merely physiological due to aging and requires appropriate evaluation. Anemia has a significant negative impact on cardiac function, cognition, sleep, frequent hospitalization, mobility, morbidity, and mortality. Anemia in the elderly is attributable to many causes: nutrient deficiencies, chronic inflammatory diseases, thyroid disorders, diabetes mellitus, gastrointestinal (GI) tumors and bleeding, chemotherapy-induced anemia, and drug-induced hemolysis. Objectives: We aimed to evaluate the clinical and hematological profile of anemia in 100 patients aged above 60 years. Methods and Material: We performed a cross-sectional type of study in a tertiary care center including male and female patients aged 60 years and above and whose hemoglobin was less than 13 g/dl and less than 12 g/dl, respectively. Clinical history, complete blood picture, and peripheral smear were obtained in all patients. Serum iron profile was done in patients with micro-normocytic anemia. Vitamin B12 and folate assays were done in patients with normo-macrocytic anemia and those with pancytopenia. Bone marrow studies and endoscopies were done in cases wherever deemed appropriate. Results: The majority of the patients had either severe or moderate anemia. 49% of the patients had normocytic anemia. The commonest cause for anemia was nutritional deficiencies (45%) followed by anemia of chronic inflammation (40%) and unexplained anemia (8%). Conclusions: It is essential that anemia deserves its due attention in clinical practice in older patients and is not normal always.

Inflammatory markers in geriatric anemia: A study from North India

“…Due to the chronic and intractable nature of these conditions, anemia is more likely to persist despite therapeutic interventions. [ 11 , 28 , 29 ] Yet, a significant subset of cases of geriatric anemia possess an inflammatory state “without a chronic inflammatory disorder.”…”

“…Thirdly, geriatrics are frequently exposed to polypharmacy and it is tough to segregate the additive effects of multiple medications from the actual cause of anemia. [ 29 ] Fourthly, the presentation of anemia in geriatrics is quite different from that encountered in younger individuals. While nutritional anemia presents with more classic manifestations, anemia due to inflammation has vague, non-specific symptomatology, which is likely to be overlooked as usual signs of aging.…”

“…[ 6 , 30 ] This subset of patients may remain inadequately treated since they may not benefit from standard hematinic therapy alone and might require additional EPO support. [ 29 ]…”

“…While the complete cure of the underlying chronic inflammatory state may not be feasible, a targeted approach toward symptomatic and supportive care at the primary level can greatly impact the geriatric health care. [ 11 , 29 ]…”

Parámetros hematológicos como apoyo diagnóstico para evaluar la anemia en edad adulta tardía

“…De ahí que el abordaje de la anemia en el adulto mayor es relevante porque en la gran mayoría de casos, los síntomas son inespecíficos. Los antecedentes patológicos deficientes debido a problemas de memoria o la ausencia de acompañantes o familiares en la consulta, así como la presencia de una o varias comorbilidades subyacentes pueden enmascarar los síntomas (Krishnamurthy et al, 2022). Además, existe una tendencia clínica a descartar la anemia porque de manera general es leve, razón por la cual se percibe falsamente como un problema menor sin darle un tratamiento oportuno (Girelli et al, 2018).…”