anemia in the elderly

7/25/2019 Anemia in the Elderly

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ANEMIA IN THE ELDERLY

Special Considerations Regarding

Management

Canadian Multicentre Anemia Symposium

22 Anemia A!areness "ee#


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Anemia in t$e Elderly

Anemia in the elderly is not part of normal aging.

Anemia is common & increases with each

successive decade.

Prevalence 10-45 with an incidence !etween 10-15

per 1000.

"igher in men than women of any given ageand in Afro-Americans.


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Special Considerations

#ultifactorial often with multiple medical pro!lems& polypharmacy.

$nset of symptoms is usually insidious & fre%uently

nonspecific.

Anemia in the elderly has increased conse%uences.

'( indices often unrelia!le.

#yelosuppression more common & severe.

)uality of life issues may !e more pronounced.


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Time o% Diagnosis

Annual medical e*amination +

$nset of acute medical pro!lem ,

ollow up of a chronic medical pro!lem

ollowing admission to hospital +5


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#ultiple diagnoses 5/

o diagnosis 1+

ingle diagnosis /0

Anemia of chronic disease 10

#alnutrition

2nfection 4

Postoperative !leeding /Alcohol 1

2ron deficiency 1

Modified from Principles of Geriatric Medicine and Gerontology 4th

ed. 1999


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Anemia o% C$ronic Disease

Most common cause o% anemia in $ospitali&ed patients'

Anemia correlates !it$ se(erity o% underlying disease'

Serum eryt$ropoietin le(els may )e inappropriately lo!'

Response to eryt$ropoietin administration (aria)le'

In selected diseases *e'g' Myeloma+ RA+ CR,- responses to

eryt$ropoietin possi)le !it$ serum le(els . 2 /0L *N+ 12 32-'


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Diseases Associated !it$ Anemia o% C$ronic Disease

Acute in%ections Malignancy

C$ronic in%ections #etastatic carcinoma

3u!erculosis "ematologic malignancies

2nfective endocarditis euemia

(hronic urinary tract infection ymphoma

(hronic fungal infection #yeloma

C$ronic in%lammatory disorders C$ronic renal insu%%iciency

$steoarthritis Hypot$yroidism

heumatoid disease 4rotein5energy malnutrition (ollagen vascular disease

Polymyalgia rheumatica

Acute and chronic hepatitis

6ecu!itus ulcer


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Anemia o% C$ronic Disease4at$ogenesis

2mpairment of iron utili7ation

2nhi!ition of erythropoeisis

'lunted response to erythropoietin

educed '( survival

4ossi)le %unctional adaptation o% innate immune system

2ron se%uestration as a micro!icidal strategy

Altered macrophage responses

Cyto#ine mediated

3h1 - 28 3, 1

3h9 : 2-48 2-108 2-;


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Iron De%' ACD

erum iron educed educed

32'( 2ncreased educed

3ransferrin saturation educed ormal

erum ferritin educed ormal or2ncreased

Plasma transferrin receptor 2ncreased ormal

3ransferrin receptor < ferritininde*

"igh ow


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Sensiti(ity 6 Speci%icity o% Serum ,erritin in Iron De%iciency Anemia

Serum %erritin

*ug per L- Sensiti(ity *7- Speci%icity *7-

Li#eli$oodratio8

. 2 9: ;1


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>12 de%iciency o%ten unrecogni&ed in t$e elderly

3ypical signs & symptoms of '19 deficiency often not present.

$nly a!out ;0 of pts. with '19 def are anemic.

'19 deficiency accounts for anemia in 5-10 of elderly patients.

2nade%uate a!sorption occurs in 10-/0 of pts. with partial gastrectomy.

Pernicious anemia undiagnosed in 9 of healthy individuals over ;0 yrs.

eurologic symptoms may precede anemia.


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Neurological presentation o% >12 de%iciencyParesthesias of fingers & toes

educed vi!ration sense =95;-"7> & proprioception

Ata*ia =(om!ined system disease>

Perversion of taste & smell

$ptic atrophy

6ementia8 #emory oss & 6epression

?#egalo!lastic #adness@ : Paranoid chi7ophrenia

pecific #2 a!normalities


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?itamin >12 de%iciencyerum '19 levels do not relia!ly predict tissue deficiency.

erum or urine methylmalonic acid & serum homocystiene

more relia!le indicators of tissue '19 levels.

creening in elderly if serum '19 9;0 pmol


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Myelodysplastic *MDS- Syndromes

Most cases occur )et!een @59 years'

MDS may represent up to 37 o% anemia in elderly'

1' Ine%%ecti(e $ematopoiesis'

- Anemia present in =597 o% cases'- Neutropenia in 37 o% cases o%ten !it$ monocytosis'

- T$rom)ocytopenia in 237 o% cases'

2' Clonal E(olution

- 15:7 de(elop AML'

- C$romosome a)normalities in :7 o% casesTrisomy =

3 6 ; deletions *CS,s-

112< *MLL gene-


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Myelodysplastic Syndromes

Supporti(e care remains maBor treatment approac$

: Trans%usions+ Amicar+ Anti)iotics

/npro(en t$erapies

: Trans%usions des%erral administration'

: Epo 5CS, Dana&ol'

Eperimental t$erapies

: Immune t$erapies AT+ CSA+ T$alidomide

: C$emot$erapy anti5CD


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Indications %or >one Marro!

9 or more cell lines affected

#onoclonal gammopathy

2ndeterminate iron status

euoerythro!lastic peripheral smear


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4otential Areas o% ,uture Researc$

Etiology 6 treatment o% myelodysplastic syndrome'

Nutritional )ene%its o% L5carnitine'

Regulation o% eryt$ropoiesis'

Com)ination gro!t$ %actor t$erapy'

Tools %or ,atigue 6 FGL assessments'

E%%ects o% anemia on sur(i(al 6 t$erapy responses in cancer'

Immunomodulatory 6 neurocogniti(e e%%ects o%

eryt$ropoietin'


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Canadian Multicentre AnemiaSymposium

22 Anemia A!areness "ee#

!!!'anemiainstitute'org

Supported by an unrestricted educational grant from Janssen-Ortho nc.

anemia in the elderly

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