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| ORIGINAL ARTICLE |
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| Year : 2016 | Volume
: 2
| Issue : 2 | Page : 98-101 |
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Factors contributing to geriatric anemia
Mathew Cherian, Renu G'Boy Varghese
Department of Pathology, Pondicherry Institute of Medical Sciences, Puducherry, India
| Date of Submission | 02-Oct-2016 |
| Date of Acceptance | 06-Nov-2016 |
| Date of Web Publication | 13-Jan-2017 |
Correspondence Address:
Mathew Cherian
Pondicherry Institute of Medical Sciences, Puducherry
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2455-3069.198371
Introduction: Among the elderly, anemia is a very common problem. Unlike when anemia occurs in younger adults, the cause of anemia in the elderly is often not readily apparent or attributable to a single cause. Anemia in the elderly is a public health crisis because it increases the risk of death by 40%.
Materials and Methods: An observational study was conducted on a cohort of patients aged 60 years and above, presenting to our hospital, fulfilling the WHO criteria of anemia. The study was carried out over a period of 2 months (June 2015–July 2015).
Results: In our study, of the 150 patients analyzed above the age of 60, 78% (119) were found to have anemia. Mean corpuscular volume was used for morphologic classification of anemia. Normocytic anemia was the most common type of anemia observed accounting for 77%. In this study, it was found that majority of the patients (50.4%) had anemia due to chronic disease, followed by unexplained anemia (29%), microcytic hypochromic anemia (probably iron deficiency anemia) (19.6%), and macrocytic anemia (1%). Out of the four chronic conditions analyzed, more number of anemic patients had diabetes, followed by chronic respiratory disease, hypertension, and renal disease.
Conclusion: This study has shown that there is a significant number of people among the geriatric population who have anemia, with anemia due to chronic disease and microcytic hypochromic anemia being the most prevalent type. This condition can most definitely be rectified. Management of anemia can definitely improve the condition of the patient. Keywords: Anemia of chronicdisease, elderly, macrocytic anemia, microcytic anemia, microcytic hypochromic anemia, normocytic anemia
How to cite this article:
Cherian M, Varghese RG. Factors contributing to geriatric anemia. J Curr Res Sci Med 2016;2:98-101 |
| Introduction | |  |
Among the elderly, anemia is a very common problem. Even mild anemia is associated with a significant increase in mortality and morbidity irrespective of the cause of underlying anemia. Unlike when anemia occurs in younger adults, the cause of anemia in the elderly is often not readily apparent or attributable to a single cause.[1] Approximately, one-third of the cases are caused due to nutritional deficiency, one-third due to anemia of chronic inflammation/renal insufficiency and one-third remain unexplained. Anemia in the elderly is a public health crisis in hematology. It is a crisis because it increases the risk of death by 40%.
Aging is not a cause of anemia; rather it predisposes the person to anemia. Anemia is defined by WHO as a hemoglobin (Hb) concentration of <13 g/dL for men and <12 g/dL for women. This prospective hospital-based study was done to study the clinical profile of anemia in elderly patients (above 60 years) and to study the hematological types and possible etiologies of anemia in such patients.[2]
In this study, patients above 60 years of age presenting to our hospital, with a Hb of <13 g/dL in males and <12 g/dL in females, were studied, mean corpuscular volume (MCV) was used to classify the anemia as normocytic anemia, microcytic, or macrocytic and the various associated diseases as the cause for the anemia were determined.
| Materials and Methods | | |
An observational study was conducted in the Department of Pathology on a cohort of patients aged 60 years and above, presenting to our hospital, fulfilling the WHO criteria of anemia (Hb <13 g/dL in males and Hb <12 g/dL in females). The study was carried out, after obtaining institutional ethics clearance, over a period of 2 months (June 2015–July 2015). The number of patients examined was 150. Since this study was based on laboratory reports, a participant information sheet was provided, and a consent form (written) was given to each patient.
The following hematological investigations were collected from the blood reports of the patients – red blood cell (RBC) count, hematocrit, Hb, MCV, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red cell distribution width (RDW), white blood cell (WBC) count, platelet count, and peripheral blood smear findings – RBC morphology, WBC, platelet, and parasite. The results for these parameters were obtained from results of complete blood count and peripheral blood smear.
Using the information from the results obtained, anemia was classified into normocytic anemia, microcytic anemia, and macrocytic anemia. Microcytic anemia was defined as MCV below 80 fl and macrocytic anemia was defined as MCV above 100 fl.
Mild anemia was defined as Hb >10 g/dL but <13 g/dL in males and <12 g/dL in females, moderate anemia was defined as Hb <10 g/dL but >7 g/dL and severe anemia was defined as Hb <7 g/dL.
| Results | | |
A total of 150 participants were studied of which 117 had anemia. Of the 117 anemic patients, 80 had mild anemia (Hb 10–13 g/dL [or] 12 g/dL), 33 moderate (Hb >7 g/dL <10 g/dL), and 4 had severe anemia (Hb <7 g/dL). Of the mildly anemic patients, 1 patient (1.25%) had raised MCV, 67 (83.75%) had normal MCV, and 12 (15%) had decreased MCV. Among the moderately anemic patients, 21 patients (63.6%) had normal MCV while 12 patients (36.4%) had decreased MCV and of the 4 severely anemic patients, 2 (50%) had decreased MCV and 2 (50%) had normal MCV. There were 90 (77%) patients with normocytic anemia, 26 (22.2%) with microcytic anemia and 1 (0.8%) with macrocytic anemia [Table 1]. | Table 1: Distribution of anaemic patients based on the Mean Corpuscular Volume (MCV)
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Among the 31 diabetic patients having anemia, there were 17 patients who had features suggestive of anemia of chronic disease, 5 patients who had microcytic hypochromic anemia, and 9 had unexplained anemia.
Among the 21 hypertensive patients having anemia, there were 10 patients who had features suggestive of anemia of chronic disease, 2 patients who had microcytic hypochromic anemia, and 9 had unexplained anemia.
From the 12 patients having a renal disorder and anemia, there were 7 patients who had features suggestive of anemia of chronic disease, 3 patients who had microcytic hypochromic anemia, and 2 had unexplained anemia.
Among the 27 patients having a chronic respiratory disease and anemia, there were 11 patients who had features suggestive of anemia of chronic disease, 8 patients who had microcytic hypochromic anemia, and 8 had unexplained anemia.
Among the 25 patients having a nonchronic condition and anemia, there were 14 patients who had features suggestive of anemia of chronic disease, 5 patients who had microcytic hypochromic anemia, and 6 had unexplained anemia.
It was found that of the 117 anemic patients, 59 (50.4%) patients had anemia of chronic disease, 23 (19.6%) had microcytic hypochromic anemia, 34 (29%) had unexplained anemia, and 1 (1%) had macrocytic anemia [Figure 1].
| Discussion | | |
Although the prevalence of anemia does increase with age, successful aging is not usually associated with anemia. Anemia should not be accepted as an inevitable consequence of aging, because a cause is identified in about 80% of elderly patients.[2] In ambulatory elderly patients, the most common causes of anemia are chronic disease (kidney disease, infections, malignancies, and chronic inflammatory disorders), iron deficiency, and nutritional and metabolic disorders. Frequently, multiple factors contribute to the problem in the individual patient. Proposed mechanisms include the presence of inflammatory cytokines and abnormal cytokine modulation of erythropoiesis, due both to abnormal production of stimulatory cytokines and decreased responsiveness of the erythroid precursors.[3]
In our study, 150 patients above the age of 60 were analyzed. 78% were found to have anemia. This is much higher when compared to numerous studies which show an average of 20%–40% prevalence of anemic patients.
MCV was used for morphologic classification of anemia. Normocytic anemia was the most common type of anemia observed accounting for 77% confirming previous studies. These results strongly tally with those found in the study conducted by Bach et al. These results suggest that MCV-based classification of anemia is not reliable and does not mirror the underlying pathogenesis.[4]
In our study, it was found that majority of the patients (50.4%) had anemia due to chronic disease, followed by unexplained anemia with 29%, then microcytic hypochromic anemia (19.6%) and macrocytic anemia (1%). This tallies with the study conducted by Bhasin and Rao.[5]
It was found that 19.6% of the patients with anemia were due to microcytic hypochromic anemia, probably iron deficiency anemia. However, this figure is based on decreased MCV and raised RDW and cannot be entirely relied upon as the iron stores of these patients were not established and therefore no confirmation of the said figure could be done.
Out of the four chronic conditions analyzed, there were more number of anemic patients having diabetes, followed by chronic respiratory disease, hypertension, and renal disease. Numerous studies, however, indicate that there was more number of anemic patients having a renal disease as the underlying chronic condition than any other disorder which is in contrast to what was obtained in this study.
Among the patients suffering from other miscellaneous conditions, 5 out of 25 had microcytic hypochromic anemia while the remaining 20 anemic patients might have had a chronic condition apart from the 4 discussed or may be drug-induced.
This study has shown that there is a significant number of people among the geriatric population who have anemia. Adequate and required investigations into the underlying cause of the anemia, once established can help in providing the right treatment. Management of anemia can definitely improve the condition of the patient.
The present study had some limitations; analyses were performed retrospectively on the basis of a single set of laboratory values, rather than repeated measurements and clinical evaluations; nutritional assessment such as ferritin levels were not estimated in the present study; sample size was inadequate to draw valid a conclusion; further studies with a larger sample size are needed to confirm the findings of this study.
| Conclusion | | |
This study highlights that there is a high incidence (78%) of anemia, among the elderly population. Most of the anemic patients have a chronic disease condition associated with it. Unexplained anemia follows as the 2nd most prevalent cause of anemia, followed by microcytic hypochromic anemia. It has also been found that the major proportion of the anemic patients have normocytic RBCs. Failure to evaluate anemia in elderly could lead to delayed diagnosis of potentially treatable conditions. An effort should always be made to reach an etiological diagnosis before instituting specific therapy.
Financial support and sponsorship
This study was supported by PIMS fellowship fund.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Makipour S, Kanapuru B, Ershler WB. Unexplained anemia in the elderly. Semin Hematol 2008;45:250-4.  |
| 2. | Smith DL. Anemia in the elderly. Am Fam Physician 2000;62:1565-72. |
| 3. | Joosten E, Pelemans W, Hiele M, Noyen J, Verhaeghe R, Boogaerts MA. Prevalence and causes of anaemia in a geriatric hospitalized population. Gerontology 1992;38:111-7. |
| 4. | Bach V, Schruckmayer G, Sam I, Kemmler G, Stauder R. Prevalence and possible causes of anemia in the elderly: A cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging 2014;9:1187-96. |
| 5. | Bhasin A, Rao MY. Characteristics of anemia in elderly: A hospital based study in South India. Indian J Hematol Blood Transfus 2011;27:26-32. |
[Figure 1]
[Table 1]
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