Anemia In Elderly Patients Research Articles

Quality of life, physical function and MRI T2* in elderly low-risk MDS patients treated to a haemoglobin level of ≥120 g/L with darbepoetin alfa ± filgrastim or erythrocyte transfusions

Anaemia in low-risk myelodysplastic syndromes (MDS) is associated with reduced quality of life (QoL). Response to treatment with erythropoietin ± granulocyte colony-stimulating factor (G-CSF) is associated with improved QoL, but whether transfusion therapy with higher haemoglobin (Hb) target levels has similar effects is unknown. The objective for this prospective phase II Nordic multicentre trial was to assess QoL, response rate and physical function in elderly anaemic MDS patients treated to a target Hb level of >120 g/L. Thirty-six elderly patients with low- and intermediate-1 risk MDS received darbepoetin (DA) 300 μg/wk, with the addition of G-CSF if no response. If the Hb target was reached at 16 wk, treatment was maintained until week 26. Remaining patients were transfused to reach the target level for at least 8 wk. Twenty-seven patients completed the study. Response rate to DA ± G-CSF was 67% in evaluable patients and 56% according to intention to treat. Eighteen patients reached the target Hb level according to protocol. QoL scores for fatigue, dyspnoea, constipation, and physical, role and social functioning improved significantly during study, with similar results for transfused and untransfused patients. Maintaining Hb >120 g/L did not confer a higher transfusion rate, once the target was reached. In two of fourteen patients, magnetic resonance imaging T2* indicated cardiac iron overload, however, without association with ferritin levels. In elderly anaemic MDS patients, an increment in haemoglobin is associated with improved QoL, whether induced by growth factor treatment or transfusion therapy.

Comparative Evaluation of the Reticulocyte Hemoglobin Content Assay When Screening for Iron Deficiency in Elderly Anemic Patients

The aim of this study was to evaluate sensitivity and specificity for reticulocyte hemoglobin content (CHr) compared to other hematimetric and biochemical iron parameters, in particular, mean corpuscular hemoglobin (MCH), when screening for iron deficiency in elderly anemic patients. Bone marrow staining negative for iron was used as the gold standard criterion for iron deficiency anemia (IDA). Sensitivity and specificity for CHr, soluble transferrin receptor (sTfR), soluble transferrin receptor/log ferritin (TfR-F index), ferritin, MCH, and transferrin saturation were determined. The best cut-off point for CHr was 30.5 pg corresponding to a sensitivity and specificity of 93% and 69% for IDA, respectively. For MCH, a sensitivity of 93% and a specificity of 86%, respectively, correspond to an optimal cut-off of 28.5 pg. Analysis of CHr was not superior to MCH with respect to sensitivity and specificity when screening for IDA in elderly anemic patients.

Anemia in Elderly Patients: An Emerging Problem for the 21st Century

Anemia is a significant problem in elderly patients. Although many anemic elderly patients can be diagnosed with nutritional deficiency, anemia of chronic inflammation or comorbid diseases that explain their decreased hematocrit, the etiology of anemia in a significant fraction remains obscure. There is evidence to suggest that the hematopoietic stem cell displays increasing erythropoietin (EPO) resistance with age. EPO levels rise in elderly, nonanemic patients, and it is hypothesized that there is an interplay between this rising demand for EPO and the decreasing ability of the aging kidney to produce adequate hormone to meet that need. There is further considerable evidence that aging is associated with increased proinflammatory cytokine expression and that many of these cytokines can contribute to EPO insensitivity. Consequently, genetic variation in the expression of these proinflammatory cytokines may influence the development of anemia in elderly patients, both through induction of hepcidin expression (anemia of inflammation) and through cytokine suppression of erythroid colony formation. The impact of inflammatory mediators, EPO insensitivity, and other factors that may act on the hematopoietic stem cell to decrease erythropoiesis are under active study and should serve to elucidate the pathophysiology of this important cause of morbidity and mortality in elderly individuals. A better understanding of the pathophysiology of anemia in elderly patients should provide critical entry points for interventions that will improve survival and quality of life in the aging population.

Anemia en el anciano

Anemia is a common disorder in the elderly and is associated with increased morbidity and mortality. In elderly subjects, in whom anemia is highly prevalent, there are several aspects, such as a hemoglobin at a level which should concern us limit, or identifying its causes, that are not easy to establish. This review focuses on knowing what is considered to be normal hemoglobin levels in adults and the common causes and potential consequences of anemia in elderly patients. It provides a diagnostic algorithm and an approach to treatment that addresses new treatments such as parenteral iron drugs and erythropoiesis-stimulating agents.

Anämie im Alter – eine diagnostische und therapeutische Herausforderung

Anemia in elderly patients should never be regarded as a normal physiological response to aging. The main categories of anemia in older patients are the nutritional anemia attributed to iron deficiency, including blood loss, folate and vitamin B12 deficiency, anemia of chronic disease in patients with cancer, infections and other chronic inflammation. A further category is the unexplained anemia due most probably to impaired corrective mechanisms to stress in older persons. Investigations such as a complete blood count, red cell indices and morphology, reticulocyte count, iron parameters, vitamin B12 and folate will detect the underlying disease in many cases, when anemia is classified according to red blood cell mean corpuscular volume. Microcytic anemia is typically for iron deficiency, but normocytic anemia can also be found in iron deficiency or anemia of chronic disease. Anemia due to vitamin B12 or folate deficiency is typically macrocytic. The treatment should aim to correct the underlying cause of disorder. Recombinant human erythropoietin is a standard treatment in anemia associated with chronic renal failure and tumor-associated anemia, but not in other forms of anemia. Regular blood transfusions may be required for elderly patients with chronic anemia.

Pathologic conditions associated with elevated plasma soluble transferrin receptor levels in elderly iron replete anemic patients

Iron-deficiency anemia (IDA) in men and post-menopausal women is commonly caused by an imbalance between dietary iron absorption and blood loss via the gastrointestinal tract. In younger, otherwise healthy individuals IDA is accompanied by typical changes in the biochemical iron status, i.e. iron, ferritin and transferrin saturation (TSAT) are subnormal, whereas total iron binding capacity (TIBC) is increased [1]. In elderly anemic patients who may suffer from concurrent diseases, e.g. infections, inflammatory diseases or cancer, the biochemical iron status is often difficult to interpret since it is influenced by acute phase responses [2]. Anemia induced by an inflammatory response is commonly referred to as anemia of chronic disease (ACD) and characterized by a blockage of iron in the reticuloendothelial system. A bone marrow examination is often required to discriminate between IDA and ACD in elderly patients with concurrent diseases. IDA is characterized by the absence of stainable.

Plasma soluble transferrin receptor assay when screening for iron‐deficiency in an unselected population of elderly anaemic patients

Plasma soluble transferrin receptor assay when screening for iron-deficiency in an unselected population of elderly anaemic patients

Anaemia in older people with chronic heart failure: The potential cost

Studies suggest benefits from correcting anaemia in heart failure using a combination of erythropoiesis-stimulating agents (ESAs) and intravenous iron. We set out to investigate the number of older patients who would require treatment of anaemia in a large teaching hospital in the United Kingdom and the cost implications. The prevalence of anaemia and chronic kidney disease (CKD) in patients 65 years and older with systolic dysfunction attending the local heart failure clinic was determined. The projected numbers of patients in our health district who would meet published kidney disease guidelines for treatment of anaemia was then estimated. The costs of treatment with combination ESAs and IV iron were calculated for these patients based on the treatment costs for renal anaemia in our local renal unit. Sensitivity analysis for different thresholds of haemoglobin and eGFR was performed. In our study of 86 heart failure patients, mean age 81 years, 34% have anaemia and 73% have stage III CKD with estimated glomerular filtration rate < 60 ml/min/1.73 cm2. At the haemoglobin threshold value of <of=11.0 g/dl for treatment of anaemia in heart failure patients with stage III CKD, 1031 elderly heart failure patients in our health district (total population 424,654) would require treatment with IV iron and erythropoietin, at a cost of pound2.7 million per annum. The estimated cost of treating anaemia in elderly patients with heart failure using ESAs and IV iron is substantial and its cost effectiveness is unknown.

Post-operative anaemia in femoral neck fracture patients: Does it need treatment? A single blinded prospective randomised controlled trial

A prospective randomised controlled trial was performed to establish the effect of oral iron supplementation on haemoglobin level at 4 weeks post-operative in elderly patients with fractured neck of femur undergoing surgical treatment. We single blindly randomised 68 patients into two groups. Thirty-four patients in the treatment group were compared with 32 in the control group. The treatment group received 200 mg of oral iron tablets 3 times a day for 4 weeks in the post-operative period compared to nothing for the control group. The groups were comparable in all other aspects. The iron treatment resulted in significantly increased haemoglobin value at 4 weeks; 0.76 g% higher than the control group (95% CI of +0.01 to +1.51) which is statistically significant ( P < 0.05). There was no major complication. We recommend oral iron supplementation in elderly anaemic patients with hip fracture in the post-operative period.

First Hematological Signals of Latent Anemia to Aging Population

Anemia is an independent risk factor for morbidity and mortality in an array of disorders common to seniors including cancer, renal diseases and heart diseases. The aim of this study was to identify the first hematological signals of latent anemia to aging population using as screening the hematological aspects of cells from peripheral blood and additional tests, establishing the etiology of anemia in the elderly.Method: Additional to level of hemoglobin(HGB) and hematocrit (HCT) have been included Hematological Indexes( MCV, HCV, MCHC ), red cell distribution width,(RDW), reticulocyte count (RET), serum iron (SI), total iron binding capacity,(TIBC), transferrin saturation index, (TSI), serum ferritin( SF), on an study of 140 adult hospitalized patients, in wars with chronic diseases males and females with ages past 65 years. Anemia of chronic diseases (ACD) is more common in the elderly than other group.In ACD correlation of hematological testes was following: 32 % with normal HGB, HCT and normal hematological indexes, 21.5 % with only MCV or HCV decreased, 22.5 % patients with HB in value 10.8 g/dl for women and 11.08 g/dl form men, 15 % patients with HB 9.8-10.6g/d L and 9% patients with HB 7.8-9.6, g/d L (mean SD=2,2 ); average number of Reticulocytes =1.2%; Corrected Index Ret = 0.6%; Production Index Reticulocytes, (PIR) = 1.4, meaning the hypo-regenerative anemia with globular value, GV =1.2. Precision: CV < 2% for RBC, CV < 1% for HB and CV < 2% for HCT. Accuracy: R > 0.95 for RBC, HGB and HCT. In this study was observed a higher prevalence of anemia in elderly men than in women. Anemia of renal disease is considered to be a distinct form of anemia and is typical due to decreased EPO production in 20 percent from normal value to adult persons. Discussion: Elderly anemic patients fail to show increases in erythrocytes progenitors and reticuloculocytes as a result of chronic stress along life. In some cases, the presence of anemia may reflect an underling or undetected medical condition. Most anemic adults are asymptomatic until HGB fall below normal values. For this reason a routine anemia screening should be recommended by HB, HCT and MCV, HCV, MCHC to persons with age past >_65 year.

First Hematological Signals of Latent Anemia to Aging Population

AbstractAnemia is an independent risk factor for morbidity and mortality in an array of disorders common to seniors including cancer, renal diseases and heart diseases. The aim of this study was to identify the first hematological signals of latent anemia to aging population using as screening the hematological aspects of cells from peripheral blood and additional tests, establishing the etiology of anemia in the elderly.Method: Additional to level of hemoglobin(HGB) and hematocrit (HCT) have been included Hematological Indexes( MCV, HCV, MCHC ), red cell distribution width,(RDW), reticulocyte count (RET), serum iron (SI), total iron binding capacity,(TIBC), transferrin saturation index, (TSI), serum ferritin( SF), on an study of 140 adult hospitalized patients, in wars with chronic diseases males and females with ages past 65 years. Results: Anemia of chronic diseases (ACD) is more common in the elderly than other group.In ACD correlation of hematological testes was following: 32 % with normal HGB, HCT and normal hematological indexes, 21.5 % with only MCV or HCV decreased, 22.5 % patients with HB in value 10.8 g/dl for women and 11.08 g/dl form men, 15 % patients with HB 9.8-10.6g/d L and 9% patients with HB 7.8-9.6, g/d L (mean SD=2,2 ); average number of Reticulocytes =1.2%; Corrected Index Ret = 0.6%; Production Index Reticulocytes, (PIR) = 1.4, meaning the hypo-regenerative anemia with globular value, GV =1.2. Precision: CV &lt; 2% for RBC, CV &lt; 1% for HB and CV &lt; 2% for HCT. Accuracy: R &gt; 0.95 for RBC, HGB and HCT. In this study was observed a higher prevalence of anemia in elderly men than in women. Anemia of renal disease is considered to be a distinct form of anemia and is typical due to decreased EPO production in 20 percent from normal value to adult persons. Discussion: Elderly anemic patients fail to show increases in erythrocytes progenitors and reticuloculocytes as a result of chronic stress along life. In some cases, the presence of anemia may reflect an underling or undetected medical condition. Conclusions: Most anemic adults are asymptomatic until HGB fall below normal values. For this reason a routine anemia screening should be recommended by HB, HCT and MCV, HCV, MCHC to persons with age past &gt;_65 year.

Final results of a prospective, observational study of the effectiveness of darbepoetin alfa administered every three weeks for the treatment of chemotherapy-induced anaemia in elderly patients

e20654 Background: Cancer incidence is increasing in elderly but specific treatment data in this population is not often available. The objectives of this study were to evaluate the effectiveness and safety of darbepoetin alfa (DA) administered once every 3 weeks (Q3W) for the treatment of chemotherapy-induced anaemia (CIA) in elderly within routine clinical practice. Methods: Prospective, observational, single-arm, multicentre study performed in 28 centres across Spain. Eligible patients (pts):≥65 years, anaemic (haemoglobin [Hb] 11 g/dl), with non-myeloid malignancies, and scheduled to receive ≥9 weeks (wks) of chemotherapy. Pts were treated with a fixed dose of DA 500 μg Q3W and treatment stopped if Hb levels exceeded 13g/dl. Primary endpoint was hematopoietic response (Hb increase ≥2g/dl or Hb ≥12g/dl without transfusions in the previous 28 days). Secondary endpoints included percentage of pts achieving target Hb (&gt;11g/dl from wk 5 till end of treatment without red blood cell transfusion within 28 days), changes in the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scale and the incidence of adverse reactions. Results: Data were prospectively collected from 153 pts: women (56.86%), mean (SD) age 73.43 (5.77) years, ECOG Performance Status 0–1 (65.36%) with solid tumors (66.67%) and lymphoproliferative malignancies (33.33%) and stage III/IV (63.40%). Most pts (90.20%) had baseline Hb levels between 9–11g/dL. DA was administered for a median of 9.0 wks (range: 1–22.57). The Kaplan-Meier percentage (KM; 95% CI) of pts who achieved hematopoietic response was 69.70% (56.06–83.34) and 72.22% (57.5–86.94) for pts who achieved target Hb (&gt;11g/dL). FACT-F median score at baseline was 29.00 and 33.00 at the end of the study. Only one (0.7%) non-serious adverse reaction (cutaneous eruption) was reported. Conclusions: These results suggest that DA given at 500 μg Q3W to elderly pts with non-myeloid malignancies is an effective and well-tolerated treatment for CIA. [Table: see text]

Reduced erythropoietin response to anaemia in elderly patients with normocytic anaemia.

We studied the effect of age on the relationship between haemoglobin and serum erythropoietin (EPO) levels in anaemic patients. 568 patients over 70 years of age were compared with 137 patients under 70 and a reference group of 144 patients of all ages with proven iron deficiency. EPO was measured using a radioimmunoassay. We found that elderly patients with a normocytic anaemia (N = 375) had a statistically lower EPO response than younger patients with normocytic anaemia (N = 61) (p < 0.05) or patients of all ages with iron-deficiency anaemia (p < 0.05). There was no difference between the sexes. Elderly patients with microcytic or macrocytic anaemia had a normal EPO response as compared to the "gold standard" of iron deficiency. These findings suggest that a proportion of elderly patients with normocytic anaemia has an impaired EPO response.

Diagnostic Yield of Water Enema Computed Tomography (WECT) in First Line Investigation for Lower GI Bleeding in Elderly Patients

Background: Colonoscopy is not always easy to perform in elderly patients presenting multiple comorbidities and treated by antiplatelet agents and/or vitamin K antagonists. Indeed, anesthesia, bowel preparation for colonoscopy and a stop of antiplatelets agents or anticoagulant may compromise the cardiac prognosis. Aim: To evaluate the diagnostic yield of WECT in first line investigation for lower GI bleeding or iron-deficiency anemia in elderly patients with multiple comorbities. Method: From June 2007 and June 2008, we performed a WECT for iron-deficiency anemia (n=47), hematochezia (n=29), a positive FOBT (n=2) in 83 patients [47Female/36male, median age 81,2 yrs (65-94)].

Prevalence of anemia in elderly patients in primary care: impact on 5-year mortality risk and differences between men and women

ABSTRACTBackground: Increased mortality in patients with anemia has been demonstrated in disabled, seriously ill or hospitalized patients. In industrialized nations with their aging societies, however, elderly but apparently healthy family-physician patients are an important demographic group from a public-health perspective. We therefore set out to evaluate the prevalence of anemia in this group and associations between anemia and 5-year all-cause mortality, adjusted for multiple other established risk factors and chronic diseases.Methods: This was a monitored, prospective cohort study in Germany with 344 representative family physicians who documented, consecutively, elderly patients (aged ≥ 65 years). Extensive fasting plasma parameters were collected at baseline. Anemia at inclusion was defined according to World Health Organization criteria (hemoglobin below 12 g/dl in women and 13 g/dl in men). All participants were followed up for death of any cause for 5.3 years.Results: Among the 6880 individuals, 2905 men and 3975 women, aged 65–95 (mean age 72.5), mild anemia (hemoglobin levels ≥10 g/dl) was found in 6.1% of women and 8.1% of men. Among those patients, 36.1% of anemic men and 15.0% of anemic women died. In a Cox proportional hazards analysis, multiple adjusted for potential confounders including major comorbidities, a near doubling of the 5-year mortality risk in anemic men (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.5–2.4) was found, while in anemic women there was no risk increase at all (HR 1.1; 95% CI 0.8–1.6). Even if patients with the lowest hemoglobin concentration (<11 g/dl for women, <12 g/dl for men) are singled out for multiple-adjusted analysis, anemia in men was related to a significant mortality risk (HR 3.3; 95% CI 2.1–5.1), but not in women (HR 1.85; 95% CI 0.97–3.53).Conclusion: In typical elderly patients without severe comorbidities, mild anemia was significantly associated with greater mortality in men but not in women. Given the impact of sex on outcomes of older subjects with mild anemia, the current definition of anemia should be adjusted for elderly males towards a higher hemoglobin threshold. Interventional trials will be needed to determine whether a consistent correction of anemia improves mortality of older men.

Management of Postoperative Anemia After Lower Limb Arthroplasty in Patients Over 65 Years Old

In Response: We agree with Munoz et al.1 regarding the importance of considering options other than blood transfusion to prevent or treat postoperative anemia in elderly patients after lower limb arthroplasty. This group reports considerable efficacy in maintenance of hemoglobin concentration in patients over 65 yr after primary knee arthroplasty with a regimen of perioperative iron ± erythropoietin.1 In our study, we found a positive correlation between hemoglobin levels on hospital discharge and quality of life at 2 mo postoperatively in those older than 65 years after primary hip arthoplasty.2 Whether the targeted hemoglobin level is achieved by blood transfusion or perioperative iron and erythropoietin, it may result in improved quality of life scores in this patient population. Niamh P. Conlon, MBBChBAO, FCARCSI Eilis P. Bale, RGN G. Peter Herbison, MSc Maire McCarroll, FCARCSI Mater Misericordiae University Hospital Newcastle, Australia [email protected]

Iron Status and Colorectal Cancer in Symptomatic Elderly Patients

Objective The study aim is to determine the relationship between the prevalence of colorectal cancer and iron status in elderly anemic and non-anemic patients. Methods We retrospectively investigated 359 consecutive elderly patients, aged 70 years and more, who presented to a geriatric department and who underwent a total colonoscopy. The histopathologic diagnosis of colorectal carcinoma was the primary outcome measure, and its presence was compared with the iron status, evaluated by serum ferritin and hemoglobin levels. Results Less than half of the patients with colorectal carcinoma had iron-deficiency anemia. The prevalence of colorectal carcinoma was similar among patients with a serum ferritin level less than 50 μg/L (16%), between 50 and 100 μg/L (20%), and greater than 100 μg/L (13%), and was not different between anemic and non-anemic patients. Sex (odds ratio for men 2.1; 95% confidence interval [CI], 1.2-3.9) and increasing age (6.6% per year; 95% CI, 1.2-12.4), but not hemoglobin and serum ferritin, were independent risk factors for colorectal carcinoma. Those with a proximal colorectal carcinoma had a lower hemoglobin and ferritin level and a higher prevalence of iron-deficiency anemia compared with patients with a distal colorectal carcinoma. Conclusion The prevalence of colorectal carcinoma is high in anemic and non-anemic elderly symptomatic patients, irrespective of the iron status. Therefore, the decision to order a colonoscopy in older patients should not only be considered in patients with anemia or iron deficiency but also in patients with suspicious symptoms without anemia or iron deficiency.

Postoperative Anemia and Quality of Life After Primary Hip Arthroplasty in Patients Over 65 Years Old

It is uncertain whether anemia in elderly patients after primary hip arthroplasty has an effect on their quality of life. We conducted a prospective observational study over 3 mo to investigate the association between discharge hemoglobin levels and subjective experience of quality of life at 2 mo postoperatively in patients aged over 65 yr who were scheduled for primary hip arthroplasty. Quality of life was measured preoperatively and at 2 mo postoperatively using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Functional Assessment of Cancer Therapy Anemia (FACT-Anemia) subscale. Pearson correlation coefficients between change in SF-36 and FACT-Anemia subscale scores (from preoperatively to 2 mo postoperatively) and hemoglobin on Day 8 were calculated. Eighty-seven patients were included in the study. Data were available at 2 mo postoperatively from 79 of these patients. The correlation between Day 8 postoperative hemoglobin and change in SF-36 was 0.49 (P < 0.0005) and change in FACT-Anemia subscale score was 0.46 (P = < 0.0005). The correlation was not significantly changed after adjusting for advancing age, presence of significant cardiovascular disease, or whether the patient was transfused. We found a positive correlation between hemoglobin levels on discharge and change in quality of life scores from preoperatively to 2 mo postoperatively in patients over 65 yr old after primary hip arthroplasty.

Anemia in an aging population.

1. Rebecca J Laudicina, PhD[⇑][1] 1. is professor, Clinical Laboratory Science, Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill NC 1. Address for Correspondence: Rebecca J Laudicina PhD, Division of Clinical Laboratory Science, 4110 Bondurant Hall, CB#7145, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7145. (919) 843-4350. Rebecca_Laudicina{at}med.unc.edu 1. State the World Health Organization criteria for defining anemia and discuss issues related to this definition. 2. Compare the prevalence of anemia in a variety of subgroups in persons over age 65. 3. Discuss the physical, cognitive, and economic impact of anemia in the elderly. 4. Characterize the major causes of anemia in the geriatric population. 5. Explain laboratory tests and results useful in identifying the cause of anemia in the elderly. Demographic data combined with the results of recent studies indicate that anemia is a significant health concern for our aging population. As of 2006, more than 37 million people in the United States are over age 65 with that number expected to reach 80 million by the year 2050.1,2 More than 10% of all individuals above age 65 have anemia. Furthermore, the prevalence of anemia increases with age, making our oldest seniors even more likely to develop anemia during their lifetimes.3 The significance of these facts led to a special symposium, “Anemia and the Elderly: A Public Health Crisis in Hematology”, conducted at the 2005 meeting of the American Society of Hematology.4 Although the presence of anemia may reflect an underlying or undetected medical condition, anemia is also an independent risk factor for morbidity and mortality in an array of disorders common to seniors, including cancer, renal disease, and heart disease.5 Furthermore, anemia affects physical and mental functioning and interferes with the ability to conduct activities of daily living, thus affecting quality of life. Because the elderly, defined by the US Census Bureau as persons over age 65, is the fastest growing segment of the US population, anemia may be projected to have an increasing impact on our healthcare system.2 In spite of these facts, anemia in elderly patients may be overlooked in medical evaluations due to similarity of symptoms with other disorders and lack of awareness of its prevalence. Diagnosis of anemia and determination of its cause are highly… ABBREVIATIONS: ACD = anemia of chronic disease; CBC = complete blood count; CHr = reticulocyte hemoglobin; EPO = erythropoietin; HGB = hemoglobin; HCT = hematocrit; IDA = iron deficiency anemia; MA = megaloblastic anemia; MCV = mean cell volume; MCH = mean cell hemoglobin; MCHC = mean cell hemoglobin concentration; RDW = red cell distribution width; RET = reticulocyte count; SI = serum iron; sTR = serum transferrin receptor;TIBC = total iron binding capacity; TS = transferrin saturation. 1. State the World Health Organization criteria for defining anemia and discuss issues related to this definition. 2. Compare the prevalence of anemia in a variety of subgroups in persons over age 65. 3. Discuss the physical, cognitive, and economic impact of anemia in the elderly. 4. Characterize the major causes of anemia in the geriatric population. 5. Explain laboratory tests and results useful in identifying the cause of anemia in the elderly. [1]: #corresp-1

高齢者の貧血をどう診るか

高齢者の貧血をどう診るか