Identification and Treatment of Anaemia in Older Patients

Abstract

Anaemia in elderly patients should never be regarded as a normal physiological response to aging. Underlying causes must be investigated and treated in a similar manner to that used in younger adults. In addition to a thorough history and physical examination, basic investigations such as red cell indices and morphology, reticulocyte count, haematinic assays and occasionally bone marrow examination, will detect the underlying pathology in most cases. Anaemia may be classified, according to red blood cell mean corpuscular volume, into microcytic, macrocytic and normocytic types. Anaemia with an absolute reticulocytosis is due either to acute blood loss or haemolysis. Other anaemias, more frequently encountered in elderly patients, are hypoproliferative, and reflect depressed marrow production or impaired erythroid maturation. Examples include anaemia of chronic disease and iron deficiency and, less commonly, megaloblastic anaemia and anaemia due to primary bone marrow failure. The treatment of anaemia should aim to correct the underlying cause of the disorder and/or to improve the quality of the blood, e.g. by haematinic replacement therapy. Recombinant human erythropoietin has revolutionised the treatment of anaemia associated with chronic renal failure, while its role in other anaemias is currently under investigation. Regular blood transfusion may be required for some elderly patients with chronic anaemia. However, the attendant risks of this procedure, such as iron overload and viral hepatitis transmission, must be considered.

Epidemiology of Anemia in the Elderly: Information on Diagnostic Evaluation

“…Low serum ferritin levels, high total iron‐binding capacity (TIBC) and transferrin levels, low transferrin saturation, high concentration of free transferrin receptor, and absent bone marrow iron stores accompany iron deficiency anemia 15,29–31 …”

“…Vitamin B 12 and folate are essential for the synthesis of deoxyribonucleic acid, and deficiencies in these compounds can be caused by a number of factors, as shown in Table 2 29 …”

“…26,27 Iron Deficiency Anemia Iron deficiency is common in the elderly and usually occurs as a result of chronic blood loss, gastrointestinal ulcers, colon cancer, diverticula, or angiodysplasia. 15,28,29 In some cases, inadequate intake or inadequate absorption of iron may contribute to the anemia; this is common in women who have cyclic iron loss during their reproductive life, including menstruation and pregnancy. However, in all cases, blood loss should be thoroughly investigated and excluded before assuming that iron deficiency is due to other causes.…”

Medical and Functional Consequences of Anemia in the Elderly

“…Although the prevalence of anemia is high in the elderly, it should not be perceived as an inevitable consequence of aging. An underlying cause is usually found in approximately 80% of patients 29–31 . Therefore, it is important to identify the cause and initiate relevant treatment to prevent the anemia from worsening, slow disease progression, and improve patient prognosis 29…”

Anemia: an indicator for malnutrition in the elderly

“…Malnutrition as a contributing factor is probably underestimated. Evidence of malnutrition is found frequently in hospitalized elderly patients [11,12,13]. Parameters such as serum albumin, transferrin, transferrin saturation, cholesterol, cholinesterase, vitamin B 12 , folic acid, zinc, and absolute lymphocyte count are useful to assess the nutritional status.…”