Update of nutrient-deficiency anemia in elderly patients

SummaryPatients admitted to an intensive cardiac care unit (ICCU) are a heterogeneous population with a high mortality rate. The aim of our study was to investigate which clinical, biochemical, and echocardiographic parameters routinely assessed may affect long-term mortality in a non-selected ICCU population.A total of 392 patients hospitalized between 2008-2011 (mean age, 70 ± 13.8 years, 43% women) were consecutively and prospectively assessed with the following admission diagnoses: 168 with acute coronary syndromes (ACS), 122 with acute decompensated heart failure (ADHF), and 102 with other acute cardiac disorders. Patients were treated according to the current European Society of Cardiology (ESC) guidelines.During a mean 29.3 (± 18.9) months of observation, 152 (38.8%) patients died and 7.9% of the patients needed a red blood cell transfusion (RBC Tx). Patients who died were significantly older and had lower baseline levels of hemoglobin (Hb), serum iron concentration (SIC), total iron binding capacity (TIBC), cholesterol, and left ventricular ejection fraction (LVEF), as well as lower eGFR values, and higher white blood cell (WBC) counts and C-reactive protein (CRP) levels (P < 0.05). Predictors of death in multivariate regression analysis were age, Hb, LVEF, WBC, and CRP. The most powerful factor was hospitalization for non-ACS. The risk of long-term mortality increased with decreasing levels of Hb (P < 0.001), SIC (P = 0.001), TIBC (P = 0.009), and the need for RBC Tx (P < 0.001), as well as the diagnosis of ADHF (P < 0.001) and the absence of ACS (P = 0.007).In ICCU patients, age, Hb, parameters of iron status, and LVEF are strong predictors of long-term mortality. Among the ICCU population, patients with ACS diagnosis have better survival. (Int Heart J 2016; 57: 67-72)

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“…Iron metabolism disturbances are common in patients with cardiac disorders, [12][13][14][15] which was also confirmed in our previous study.…”

Section: Discussionsupporting

confidence: 88%

Predictors of Long-Term Mortality in Patients Hospitalized in an Intensive Cardiac Care Unit

et al. 2016

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“…The remaining cases of nutrient-deiciency anemia are usually associated with vitamin B12 and/or vitamin B9 deiciency and are easily treated. In Table 1, we report our personal experience (retrospective study) of the etiology of anemia in 300 hospitalized patients of ≥65 years old [4,7].…”

Section: Etiology Of Anemia With a Focus On Nutritional Anemiamentioning

confidence: 99%

“…Biermer's disease is caused by impaired absorption of vitamin B12 due to the neutralization of intrinsic factor action in the seting of immune atrophic gastritis (loss of intrinsic factor in genetic form) [4,25]. In practice, the diagnosis of Biermer's disease is based on the presence of: (i) intrinsic factor antibodies in serum (speciicity: >98%, sensibility: around 50%) and/or (ii) autoimmune atrophic gastritis (the presence of H. pylori infection in gastric biopsies is an exclusion factor) [4,25].…”

Section: Vitamin B9 and Vitamin B12 Deiciency Anemia In The Elderlymentioning

confidence: 99%

“…Nutrient-deiciency or nutritional anemia refers to types of anemia that can be directly atributed to "nutritional disorders" [4,8]. Thus, the term nutrient deiciency or nutritional anemia covers any anemia resulting from a deiciency of nutrients essential for red blood cell formation, for example: iron; vitamins, especially vitamin B9 (folate), but also vitamin B12 (cobalamin) and vitamin C (in scurvy), and more rarely, vitamin A, vitamin E, and vitamin B2 (ribolavin), vitamin B3 (in pellagra), vitamin B6 (pyridoxine); selenium, zinc, and cooper; and protein [8].…”

Section: Deinition Of Nutritional Anemiamentioning

confidence: 99%

“…However, the most common nutrient deiciencies are iron, vitamin B9 (folic acid), and vitamin B12 (cobalamin) deiciency [4]. In clinical practice, recognition of these disorders and deiciencies is essential for optimal treatment.…”

Section: Introductionmentioning

confidence: 99%

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Nutritional Anemia in Elderly Patients of Developed Countries

Andrès¹

2018

Current Topics in Anemia

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In this chapter, we report and discuss the current literature of nutrient-deiciency anemia, also called nutritional anemia, in elderly patients in developed countries. For this purpose, a review of medical literatures was conducted searching PubMed, textbooks of hematology, internal medicine and geriatrics, and information collected from international meetings were also included. The term nutrient deiciency or nutritional anemia covers any anemia, deined by a hemoglobin level <13 g/dL (<130 g/L) in men and <12 g/dL (<120 g/L) in women, resulting from a deiciency of materials essential for erythropoiesis. Patients with nutritional anemia often have mild to moderate anemia, with hemoglobin levels between 8 and 10 g/dL (80 and 100 g/L). In practice, nutritional anemia represents one-third of all anemia in elderly patients. About two-third of nutritional anemia is associated with iron deiciency and most of those cases are the result of chronic blood loss from gastrointestinal lesions. The remaining cases of nutritional anemia are usually associated with vitamin B12 (cobalamin), most frequently related to food-cobalamin malabsorption (especially in case of atrophic gastritis), and Biermer's disease (pernicious anemia); and/or vitamin B9 (folate) deiciency, most frequently related to inadequate dietary intake or malnutrition, several drugs (as methotrexate, cotrimoxazole) and chronic alcohol intake. In clinical practice, recognition of these disorders and deiciencies is essential for optimal treatment (nutrient-deiciency replacement).

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Association of Elevated Homocysteine Level and Vitamin B12 Deficiency With Anemia in Older Adults

Gopinath¹,

Rochtchina²,

Flood³

et al. 2009

Arch Intern Med

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A recent article in the Archives 1 reported on the development of anemia in the Leiden 85-Plus Study. Folate deficiency and elevated serum homocysteine level were associated with anemia both at baseline and at the 5-year follow-up. 1 However, the authors did not assess associations between anemia and dietary and red blood cell folate levels. It is important to investigate these relationships because folate deficiency generally develops as a result of inadequate dietary intake, and red blood cell folate concentration is more reliable than serum level. 2 We therefore explored associations between anemia and elevated homocysteine level, as well as with vitamin B 12 and serum, red blood cell, and dietary folate deficiencies, in a representative population of older adults.Methods. The Blue Mountains Eye Study (BMES) is a population-based cohort study of sensory loss and other health outcomes, with methods previously reported. 3 During 1992 to 1994, 3654 participants 49 years and older were examined (82.4% participation). At 5-year follow-up examinations (BMES-2), 2335 surviving participants (75.1% of survivors; 543 had died) and an additional 1174 subjects were examined as a result of a repeated door-to-door census. This provided a second cross-sectional population sample of 3509 subjects. Of these, venous blood samples were collected from 3015 subjects. Of the 2335 survivors in BMES-2, 1952 (75.6% of survivors; 1103 persons died) were re-examined at 10year follow-up examinations (BMES-3).Anemia, elevated mean corpuscular volume, elevated homocysteine level, and folate and vitamin B 12 deficiencies were assessed using the same definitions described by den Elzen et al. 1 All possible confounders listed in the Leiden 85-Plus Study were adjusted for in our study, with the exception of obstructive lung disease and Parkinson disease. We adjusted for fractures overall rather than specifically for hip fracture, as in the study by den Elzen et al.

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Update of nutrient-deficiency anemia in elderly patients

Cited by 61 publications

References 23 publications

Predictors of Long-Term Mortality in Patients Hospitalized in an Intensive Cardiac Care Unit

Predictors of Long-Term Mortality in Patients Hospitalized in an Intensive Cardiac Care Unit

Nutritional Anemia in Elderly Patients of Developed Countries

Association of Elevated Homocysteine Level and Vitamin B12 Deficiency With Anemia in Older Adults

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