The evaluation of anaemia in an older primary care population: retrospective population-based study.

David McCartney,Daniel S Lasserson,Deborah Hay,Brian Shine

doi:10.3399/bjgpopen17x101157

David McCartney, Daniel S Lasserson + Show 2 more

Open Access

https://doi.org/10.3399/bjgpopen17x101157

Copy DOI

Abstract

BackgroundAnaemia is common in older people and the identification of potentially reversible haematinic deficiencies relies on appropriate investigation, often undertaken in primary care.AimTo determine the laboratory prevalence of anaemia, the types of anaemia observed, and the biochemical and haematological investigations undertaken to characterise any associated haematinic abnormality in older primary care patients.Design & settingA retrospective primary care based study of patients aged >65 years undergoing a full blood count in Oxfordshire, UK between 1 January 2012 and 31 December 2013.MethodConsecutive patients aged >65 years with a full blood count were identified retrospectively from a laboratory database. Patient demographics, number of blood tests and additional laboratory investigations requested were recorded. World Health Organisation (WHO) criteria were used to define anaemia.ResultsIn total 151 473 full blood counts from 53 890 participants were included: 29.6% of patients were anaemic. The majority had a normocytic anaemia (82.4%) and 46.0% of participants with anaemia had no additional investigations performed. The mean haemoglobin was lower in the anaemic group that underwent further investigation than those who did not (Hb 10.68 g/dl versus 11.24 g/dl, P<0.05): 33.2 % of patients with a microcytic anaemia (mean cell volume <80) did not have any markers of iron status measured.ConclusionA large proportion of older adults in primary care with a recent blood test are anaemic, the majority with a normocytic anaemia, with evidence of inadequate investigation. Those with lower haemoglobin are more likely to be further investigated. Further work is needed to understand the approach to anaemia in older adults in primary care.

Highlights

Anaemia is a common clinical problem in older populations.[1]
The literature acknowledges that, due to the common overlap of iron deficiency and inflammation in older patients, the sensitivity of other markers used to identify iron deficiency anaemia such as ferritin and transferrin saturation may be reduced.[24]. These findings demonstrate that a significant proportion of participants with anaemia and a normal ferritin have evidence of co-existing inflammation, potentially reducing the diagnostic value of this marker
Previous studies have examined the extent to which iron deficiency anaemia identified by GPs prompts gastrointestinal investigations with endoscopy.[18,26]. These studies both demonstrated low rates of investigation (43% and 31%), no studies that we are aware of have reported haematinic testing and laboratory evaluation following an abnormal haemoglobin result

Summary

Introduction

Anaemia is a common clinical problem in older populations.[1] It is well recognised that haemoglobin decreases with advancing age[2] and is often observed in the context of multimorbidity. The WHO categorise men with haemoglobin

Objectives

Methods

Results

Conclusion