Anaemia

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What is considered as anaemia

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a reduction in red blood cell (RBC) mass, other readily available measures that estimate RBC mass, such as hemoglobin (Hb) concentration and hematocrit (Hct), are commonly used.

Hb thresholds of less than 13 g/dL for men and less than 12 g/dL for women are the most common definitions used for anemia in the elderly.

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What is it's importance

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Symptomatic

Treatable

In elderly commonly related to GI causes including malignancy

Can precipitate other medical conditions (MI)

Low Hb is a powerful prognostic marker for multiple adverse outcomes in the elderly.

anemia differs sufficiently from the etiology in younger adults to warrant considering anemia in elderly persons as a distinct entity.

complete anemia evaluation rather then a piecemeal approach is needed for elderly.

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Epidemiology of anaemia

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Causes of anemia

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Can be multifactorial in the majority of cases of anemia in elderly persons, an etiology can be found.

The common causes

iron deficiency (with or without blood loss)

chronic disease/inflammation, and chronic kidney disease.

Other etiologies of anemia

folate or vitamin B-12, diseases of the bone marrow (eg, myelodysplastic syndromes, aplastic anemia, paroxysmal nocturnal hemoglobinuria, myeloproliferative syndromes, acute or chronic leukemia, lymphoma)

hypothyroidism

hypersplenism

and hemolytic anemia.

In a minority -no cause

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Types of anaemia

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Symptoms of anaemia

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Pathophysiology of symptoms

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Investigations

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Treatment options

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Medications in patients with anemia are used based on the cause of the anemia in an elderly person

Medications include erythropoiesis-stimulating agents,

oral mineral supplements (used in mineral deficiencies)-Unless a deficiency has been identified as a cause of anemia in an elderly person, no specific dietary intervention will be fruitful

and colony-stimulating factors (used to enhance erythropoiesis when endogenous erythropoietin [EPO] levels are low).

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Criteria for treatment

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Life style modifications

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Front 12

What is the place of activity restriction in anaemia

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Activity restrictions may be considered for symptomatic anemia in elderly patients who may have active cardiac symptoms until an appropriate cardiac evaluation has been performed.

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What are the requirements for proper Hematopoiesis

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Normal erythropoiesis in adults occurs exclusively in the bone marrow and is generally restricted to the pelvis, vertebrae, sternum, ribs, and proximal femurs.

It requires stem cells, a functioning bone marrow microenvironment, nutrients, and cytokines.

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What serves as the primary regulator of RBC production

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EPO, a glycoprotein that is a hematopoietic growth factor.

Synthesis and EPO regulation occurs primarily in the kidney, with a smaller contribution by liver hepatocytes.

renal failure inexorably leads to anemia from impaired EPO production.

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What causes erythropoiesis

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Reduced tissue oxygenation (rather than diminished RBC production), typically from anemia or hypoxia, potently stimulates a logarithmic enhancement of EPO synthesis

Elevated serum EPO levels enhance erythrocyte production primarily by inhibiting apoptosis of erythroid progenitor cells and to a lesser degree by enhancing erythroid progenitor proliferation and differentiation.

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What happens to a RBC

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The reticulocyte, an early RBC that has lost the nucleus but retained the polyribosomal reticular network, eventually emerges into the blood. After 1-4 days, reticulocytes lose this ribosomal network and mature into RBCs. Mature RBCS have an average life span in the blood of 100-120 days. Macrophages engulf senescent RBCs in the spleen, liver, and marrow.

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What serves as the largest Fe storing compartment

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RBCs serve as the largest storage compartment of iron in the body, and RBC loss often leads to iron deficiency

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Special facts about IDA in Elderly

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condition can be corrected. More importantly, iron deficiency, particularly in elderly persons, often points to an underlying gastrointestinal pathology, including malignancy.

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