Abstract
Anemia is extremely common in hospitalized patients who are old and often with multiple diseases. We evaluated 435 consecutive patients admitted in the internal medicine department of a hub hospital and 191 (43.9%) of them were anemic. Demographic, historic and clinical data, laboratory tests, duration of hospitalization, re-admission at 30 days and death were recorded. Patients were stratified by age (<65, 65–80, >80 years), anemia severity, and etiology of anemia. The causes of anemia were: iron deficiency in 28 patients, vitamin B12 and folic acid deficiencies in 6, chronic inflammatory diseases in 80, chronic kidney disease in 15, and multifactorial in 62. The severity of the clinical picture at admission was significantly worse (p < 0.001), length of hospitalization was longer (p < 0.001) and inversely correlated to the Hb concentration, re-admissions and deaths were more frequent (p 0.017) in anemic compared to non-anemic patients. A specific treatment for anemia was used in 99 patients (36.6%) (transfusions, erythropoietin, iron, vitamin B12 and/or folic acid). Anemia (and/or its treatment) was red in the discharge letter only 54 patients. Even if anemia is common, in internal medicine departments scarce attention is paid to it, as it is generally considered a “minor” problem, particularly in older patients often affected by multiple pathologies. Our data indicate the need of renewed medical attention to anemia, as it may positively affect the outcome of several concurrent medical conditions and the multidimensional loss of function in older hospitalized patients.
Highlights
The prevalence of reduced levels of hemoglobin (Hb) in the general population is estimated to be around 30%; the condition affects both sexes at all ages, in industrialized as well as in developing countries
Our data indicate the need of renewed medical attention to anemia, as it may positively affect the outcome of several concurrent medical conditions and the multidimensional loss of function in older hospitalized patients
The most common cause of anemia in the world is iron deficiency (IDA); in contrast, in elderly patients (>65 years of age), multifactorial anemia [4] and anemia related to chronic diseases (CDA) have a higher prevalence [2,3], though in some cases the condition may remain unexplained: on a whole, 40% of hospitalized and 47% of institutionalized patients are anemic [5]
Summary
The prevalence of reduced levels of hemoglobin (Hb) in the general population is estimated to be around 30%; the condition affects both sexes at all ages, in industrialized as well as in developing countries. The most common cause of anemia in the world is iron deficiency (IDA); in contrast, in elderly patients (>65 years of age), multifactorial anemia (chronic kidney disease, nutritional deficiency, occult hemorrhages, gastrointestinal blood loss, use of antithrombotic drugs, ineffective erythropoiesis,) [4] and anemia related to chronic diseases (CDA) have a higher prevalence [2,3], though in some cases the condition may remain unexplained: on a whole, 40% of hospitalized and 47% of institutionalized patients are anemic [5]. Hepcidin inhibits ferroportin activity reducing iron adsorption in the bowel, and inducing iron sequestration in macrophages and enterocytes [14]. This results in the increase of iron stores (ferritin elevation) and in the likewise reduction of transferrin saturation (TIBC): this condition is named “functional ID” [15]
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