The Case Report of a 97 Years Old Patient With Chronic Anemia and Hemoglobin Value of 1.7 g/dl and Review of the Literature (original) (raw)
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Anaemia in the elderly: An aetiologic profile of a prospective cohort of 95 hospitalised patients
2012
Background and objectives: Anaemia is a significant problem in the elderly, and the cause of anaemia in approximately one third of the general population is unidentified. To date, only a few studies have focused on hospitalised patients. Patients and methods: We prospectively included anaemic patients (according to OMS criteria) aged 65 years and older who were hospitalised in the internal medicine department. The typical clinical data were collected, and a standardised set of biological tests, including cupraemia was performed. Results: Of 360 total patients, 191 (53%) patients were anaemic; however, 96 patients were excluded because their data were incomplete. Of the remaining 95 patients that were included, 45 were men (47.4%) and 50 were women (52.6%); the mean patient age was 79.7 years (66-101 years). At least one cause of anaemia was diagnosed in 87 of the 95 (91.6%) patients, and anaemia was multifactorial in 44 of the 95 (46.3%) cases. The five most prominent causes of anaemia were inflammation (62.1%), iron deficiency (30.5%), folic acid deficiency (21%), chronic renal failure (17.9%) and cobalamin deficiency (11.6%). Microcytosis was present in only 27.5% of the patients who had an iron deficiency, and macrocytosis was present in only 7.4% of the patients who had a folic acid and/or cobalamin deficiency. The cause of anaemia could not be identified for 8 of the patients. The cupraemia was normal in all the patients. Conclusion: A predefined protocol for older hospitalised patients was ability to identify the aetiology of anaemia in 91.6% of the cases; strikingly, anaemia was frequently caused by more than one factor (43.5%). Diagnostic orientation based on the mean corpuscular volume does not appear to correlate with mean cellular volume profile. Finally, anaemia caused by an unknown aetiology is rare and copper deficiency was not documented in any case.
Scandinavian Journal of Primary Health Care, 1991
S, Risw C. Anaemia in elderly patients. Incidence and causes of low haemoglobin concentration in a city general practice. Scand J Prim Health Care 1991; 9 Haemoglobin concentration was determined in all patients (530) over 70 years of age in a general practice in Oslo during an eight month period. 72 had anaemia and were investigated further. Iron deficiency was found in 13 patients and was most often caused by gastrointestinal blood loss. Chronic diseases, particularly chronic infections and rheumatoid arthritis, were responsible for anaemia in 34 patients. Renal failure caused anaemia in 14 patients. In 10 patients we found no explanation for the anaemia. Nine patients with a previously undiscovered disease were found, six of whom could be offered some kind of treatment. We conclude that anaemia in elderly patients in general practice is often caused by chronic diseases. The main cause of iron deficiency is blood loss, and routine prescription of iron is not justified in this age group. The therapeutic benefit from routine measurement of haemoglobin concentration is small and the test should be used selectively.
UNDIAGNOSED ANEMIA AMONG HOSPITALIZED ELDERLY PATIENTS
International Journal of Medical Laboratory Research, 2021
Background and aim: All over the world, anemia is one of the most common blood disorder associated with several health problems including low physical and cognitive performance, worse clinical outcomes and increased risk of morbidity and mortality especially among elderly hospitalized patients. The current study aimed to assess the prevalence of previously undiagnosed anemia among hospitalized elderly patients who aged 60 years and older. Method: This study is a prospective population-based observational study of all elderly patients admitted at King Abdul-Aziz hospital in Taif city of Saudi Arabia. The study conducted from January 2020 to January 2021. A total of 66 elderly patients who have newly diagnosed as anemic and agreed to participate in the study were investigated to confirm their diagnosis with anemia. Results: The results of this study showed that 66 of hospitalized elderly patients were detected with low hemoglobin level and never diagnosed previously. Low MCV and Low MCH were detected in the results of 21 anemic patients. Thus, these patients were identified with microcytic hypochromic anemia. Moreover, the serum iron level for those patients were investigated and showed low result compared to control individuals. Conclusion: High number of elderly patients who, admitted to the hospital at the study period were newly diagnosed with anemia, out of those 31.8% were reported with microcytic hypochromic anemia. This study suggested that regular clinical checkup and early diagnosis of anemia among elderly are important factors to reduce or prevent the incidence of many serious health problem associated with this disorder.
Recognizing and investigating iron-deficiency anemia in hospitalized elderly people
Cmaj Canadian Medical Association Journal Journal De L Association Medicale Canadienne, 1996
Objective: To determine whether anemia is documented and appropriately investigated for iron deficiency in hospitalized elderly people. Design: Retrospective chart review. Setting: Medical clinical teaching unit (CTU) in secondary care hospital in Hamilton, Ont. Participants: Consecutive patients 65 years of age' or older admitted between April 1992 and March 1993. Outcome measures: Proportion of anemic patients for whom documentation was adequate (included in problem list in patient chart) and for whom adequate investigations were performed (measurement of serum ferritin level in anemic patients in whom iron deficiency was suspected, bone-marrow aspiration for those with intermediate probability of iron deficiency after determination of serum ferritin level, and endoscopy of upper or lower gastrointestinal tract, or both, in patients with iron deficiency). Results: Of 183 eligible patients admitted to the CTU 66 (36%) had anemia; in 47 cases (71%) the anemia was documented by house staff or attending physicians. Of the 66 anemic patients 49 had a nonmacrocytic anemia of unknown cause: 26 had their serum ferritin level measured, 5 underwent bonemarrow aspiration, and 21 were referred for gastrointestinal endoscopy. Six of eight patients with probable iron deficiency (i.e., a serum ferritin level that was diagnostic [less than 18 pg/L] or suggestive [ 18 to 45 pg/L]) underwent endoscopy; two were found to have cancer of the stomach or cecum. Only 26 of the 49 patients had adequate investigation. Conclusion: Anemia is common among elderly patients in hospital. However, iron deficiency is underrecognized and underinvestigated.
Unexplained anemia in the elderly – a real life analysis of 981 patients
Archives of Medical Science, 2019
Introduction: We aimed to analyze the prevalence of unexplained anemia (UA) and assess its characteristics, potential causes and impact on survival in an elderly population. Material and methods: Medical files of 981 patients aged ≥ 60 years consulted in one primary medical clinic in Poland in 2013-2014 were retrospectively analyzed. Anemia, defined according to WHO criteria, diagnosed during either hospitalization or outpatient treatment, from the age of 60, was included. Unexplained anemia was diagnosed if, based on available clinical data and laboratory tests and other assessments in medical records, none of the well-known types of anemia were identified. Results: Of 981 patients with anemia, UA was found in 48 (28.4%) patients (4.9% of those studied) and incidence increased with age (≥ 80 years, 12.3%). In 81.3% no full hematological diagnostics were performed. Patients with UA, as with those with defined anemia, when compared to the group without anemia were older, had more co-morbidities, were more frequently hospitalized, more frequently had dementia syndrome and obtained lower Barthel scores (p < 0.0001). In the groups of patients with UA and defined anemia, there were more deaths than in those without anemia (10% vs. 13% vs. 2%, p < 0.0001) with significant differences in survival rates observed during 3-year follow-up. Conclusions: The increasing incidence with age of UA in the elderly population, insufficient diagnosis and the higher mortality of patients with UA in comparison to the group without anemia indicate the need to develop recommendations for its management by primary care physicians.
Anemia refers to a hemoglobin or hematocrit level lower than the age-adjusted reference range in healthy children and adults. Anemia is not a specifi c disease entity but is a condition caused by various underlying pathologic processes. The clinical effects of anemia depend on its duration and severity. When a precipitous drop in the hemoglobin or hematocrit level occurs (eg, due to massive bleeding), the clinical presentation is typically dramatic and can be fatal if the patient is not immediately treated. Even then, mortality risk is very high. We report the case of a 76-year-old woman with clinical symptoms and laboratory confi rmation of severe anemia with level of hemoglobin 24 g/l, and hematocrit 0.08. Anemia was a sign of malignoma of the stomach, later patohistologicaly verifi ed gastric adenocarcinoma. Aim of management is to prevent tissue hypoxia by maintaining an adequate circulating volume and oxiform capacity. However, as shown in this case, the very rapid correction of anemia and the circulatory volume does not decrease the risk of fatal outcome.
Archivos de Bronconeumología, 2013
Background: Anaemia is one of the extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD). Its real prevalence, physiopathology and clinical repercussion are unknown. The objectives of our study were: to determine the prevalence of anaemia in patients with stable COPD not attributable to other causes and to establish the relationship of anaemia with clinical, prognostic and inflammatory markers with an important role in COPD. Methods: The study included stable COPD patients with no other known causes of anaemia. The following tests were carried out: respiratory function tests; serum determination of erythropoietin and inflammatory markers: high sensitivity C-reactive protein (hs-CRP), fibrinogen, interleukin 6 (IL-6), interleukin 8 (IL-8) and tumour necrosis factor ␣ (TNF-␣). Body mass index (BMI), Charlson and BODE indices, the number of exacerbations in the previous year, dyspnoea and quality of life were also calculated. Results: One hundred and thirty patients were included. Anaemia prevalence was 6.2%. Mean haemoglobin value in anaemic patients was 11.9 ± 0.95 g/dL. Patients with anaemia had a lower BMI (P=.03), higher Charlson index (P=.002), more elevated erythropoietin levels (P=.016), a tendency to present a lower FEV 1 % value (P=.08) and significantly lower IL-6 values when compared to non-anaemic patients (P=.003). Conclusions: In our series, the anaemia associated with COPD was less prevalent than that published in the literature to date, and was related to certain clinical and inflammatory markers.
Anemia in the elderly: usefulness of an easy and comprehensive laboratory screen
Annales de biologie clinique
Anemia, the most common hematological disorder in the elderly, increases the risk of mortality and morbidity and adversely affects quality of life. However, few studies focused specifically on anemia in the elderly, especially regarding the underlying causes. The main objective of this prospective study was to evaluate the causes of anemia in non-institutionalized elderly patients. We included 190 consecutive patients ≥70 years, admitted to a geriatric short-stay unit over a 1-year period. When the hemoglobin level was <120 g/L, the following serum assays were performed routinely: iron, ferritin, transferrin saturation, folate, vitamin B12, C-reactive protein, TSH, albumin, and haptoglobin. When these tests were normal, bone marrow aspiration was performed to look for myelodysplastic syndrome. Hemoglobin was <120 g/L in 83 (43.7%) of 190 included patients. Patients with anemia had a mean hemoglobin level of 105 ± 11 g/L. The most common potential causes of anemia were inflamma...
Italian Journal of Medicine
Anemia is highgly prevalent among elderly and few previous studies have focused on hospitalized medical patients aged ≥ 75 years. During a four-months period of this single center prospective cohort study, 508 patients were admitted and studied with a standardized set of blood tests. Anemia, defined as by WHO, was present in 277 (54.5%) and in the majority of cases was mild (71.8%), normocytic (82.8%), hypoproliferative (90.5%). Most frequent diagnosis was multifactorial anemia (47.7%); anemia of chronic disease was the most frequent single cause (28.5%) and the most frequent etiologic co-factor among multifactorial anemia. Iron deficiency was found in 22.7% of cases; vitamin B12 and folate deficiency were found in 7.5% and 26.1% respectively; chronic kidney disease in 16.2%; overt bleeding anemias in 4.8% and clonal hemopathies in 3.2%. Unexplained anemia was diagnosed only in 5.1% of cases. The finding of a very high frequency of anemia of chronic disease and multifactorial anemia...