Are there elderly people around you who used to be in good health but now often feel dizzy, lose their appetite and get tired easily? For the elderly, small symptoms often have big hidden dangers and need to be treated with vigilance and caution. These seemingly uncommon symptoms indicate that these seniors may be suffering from anemia! What are the causes of anemia in the elderly? What should be done to treat it?
Story 1
Tom is 70 years old and has been experiencing weakness in his legs, shortness of breath on the stairs and poor appetite. The doctor gave him a blood test and found that his hemoglobin was only 7.8g/L. Further examination revealed that his ferritin was reduced, his vitamin B12 was also reduced, and his folic acid was normal. It turned out that Tom had undergone a major gastrectomy 20 years ago due to hemorrhage from a gastric ulcer and had not had any further bleeding or discomfort since then, so he had not been checked again. Now the cause of Tom's anemia is nutritional anemia, lack of iron and vitamin B12, most likely due to poor absorption of iron and vitamin B12 after the major gastrectomy. However, because Tom is an elderly man, he is still recommended to have a gastroscopy and colonoscopy to rule out gastrointestinal tumors.
Story 2
Peter, currently 65 years old, had a routine blood test due to a cold and fever and was found to have not only anemia but also leukopenia and thrombocytopenia. The physician suggested a bone marrow test, but Peter was reluctant to do it because he heard that it would be very harmful to his body to have a bone marrow draw. Within a year, Peter's blood indicators were getting lower and lower, and various infections occurred repeatedly, and pneumonia was born three times. Under the strong persuasion of his family, Peter underwent a comprehensive bone marrow examination, as well as chromosomal and genetic tests, and was finally diagnosed with myelodysplastic syndrome. After the bone marrow was drawn, Peter said that the bone aspiration was not so painful and uncomfortable.
Story 3
Judi had renal anemia due to renal insufficiency, with a hemoglobin of 8.2g/L. She also had mild hypertension, which could be controlled in the normal range by taking antihypertensive drugs. After one month, her hemoglobin returned to normal, but she felt dizzy and uncomfortable, which turned out to be due to her elevated blood pressure. After reducing the dose of erythropoietin and adjusting the dose of antihypertensive drugs, her hemoglobin and blood pressure were well controlled.
What is anemia in the elderly?
Anemia in adults is defined as hemoglobin (hematocrit) below 12 g/L in men and 11 g/L in women. Anemic patients with hemoglobin above 9 g/l are considered mild, between 6-9 g/l are considered moderate, and below 6 g/l are considered severe. The diagnostic criteria for anemia in the elderly are the same as those for adults, and hemoglobin can be slightly lower in men over 85 years of age, but should not be less than 10 g/L.
What are the causes of anemia in the elderly?
According to the causes of anemia, we usually classify elderly anemia into: nutritional anemia, renal anemia, chronic disease anemia (also called inflammatory anemia), myelodysplastic syndrome (MDS), anemia due to other blood disorders and anemia of unknown cause. However, it is worth noting that a large proportion of elderly anemia is the result of a combination of multiple factors, as the elderly often combine multiple underlying diseases or underlying pathological changes and may take multiple medications.
1. Causes of Nutritional anemia in the elderly: The main causes of anemia are defined as iron deficiency, vitamin B12 deficiency or folic acid deficiency anemia. Iron deficiency anemia is usually also checked for various gastrointestinal disorders, especially to rule out gastrointestinal tumors, and gastroscopy and colonoscopy should be routinely done. Atrophic gastritis can lead to malabsorption of vitamin B12 and cause a type of megaloblastic anemia called megaloblastic anemia. Inadequate intake of fresh vegetables and fruits, certain drugs and alcohol abuse can lead to folic acid deficiency, which can also cause megaloblastic anemia.
2. Causes of Renal anemia in the elderly: It is a kind of anemia secondary to renal insufficiency.
3. Causes of Chronic disease anemia in the elderly: It refers to anemia secondary to various chronic diseases, such as acute and chronic infections, malignant tumors and chronic inflammatory diseases (e.g. rheumatic immune diseases).
4. Causes of Myelodysplastic syndrome in the elderly: It is a kind of hematological malignancy, formerly called "pre-leukemia", which, as the name suggests, can be transformed into acute leukemia, so it is a disease that needs to be taken seriously and can be diagnosed only after bone aspiration, chromosomal and genetic examinations.
Bone marrow hematopoiesis, such as aplastic anemia, can have very severe anemia.
There are also some cases of senile anemia that we cannot figure out the cause of after many tests, and we call them unexplained anemia. Some people compare unexplained anemia to a "dustbin" of causes, because all anemias of unknown diagnosis can be classified as such, so this diagnosis should be made with caution and frequent follow-up to observe changes, so that the cause of the anemia may be clarified as the disease progresses. It is currently thought that the cause of the inflammatory state associated with aging may be the mechanism of this anemia.
What should I do about the cause of anemia in the elderly?
With the initial diagnosis of the cause of anemia, targeted early treatment, and formal treatment as recommended by a specialist, can be helpful in improving the symptoms of anemia in the near term and improving the quality of life in the long term in older adults. So how should elderly anemia be treated?
1. Nutritional supplementation: If the cause of anemia is iron deficiency anemia, oral iron supplements such as ferrous succinate are preferred, 1 tablet each time, 3 times a day, orally with meals. Usually the hemoglobin starts to rise after 2 weeks of treatment and returns to normal after about 2 months, but iron supplementation needs to be continued after the anemia is corrected for a total course of 4-6 months, thus ensuring that the body's iron reserves are fully restored. If elderly patients have poor memory, cannot take their medication on time every day, or have a large part of their stomach removed for malabsorption, or experience side effects such as stomach discomfort that cannot be tolerated, they can opt for intravenous iron supplementation. After continuous improvement, most of the intravenous iron supplements on the market today are effective, safe and have few side effects. However, it must be reminded that iron should not be applied for a long time and should be stopped promptly after reaching the calculated total amount of iron supplementation.
In addition, the search for the cause of iron deficiency anemia and the corresponding control measures should be carried out simultaneously. Because digestive tract diseases are the main cause of iron deficiency anemia, correct localization of the lesion may even save lives, especially in the presence of underlying malignancies.
It is also important to start supplementation with the appropriate nutrients as soon as possible in the case of vitamin B12 and folic acid deficiency, which are the causes of anemia. Vitamin B12 is usually supplemented by intramuscular injection, while it should be given intravenously for patients with clotting abnormalities such as hemophilia, or orally for vegetarians. Folic acid is usually taken orally and generally has no significant side effects.
2. Erythropoiesis-stimulating hormone (ESAs) supplementation: In our body, there is a hormone-like substance, erythropoietin (EPO), secreted by the kidneys and liver, whose secretion increases when the body is anemic or in a state of hypoxia, thus promoting the proliferation of red blood cells and improving our performance of hypoxia. If a patient has a renal cause of anemia, or a chronic disease cause of anemia, the level of EPO in their body will not meet the compensatory needs, i.e. the body cannot produce enough EPO, at this time, supplementation with exogenous EPO, i.e. erythropoietin, will be helpful. Using subcutaneous injections, 2-3 times a week, anemia usually improves after 1-2 months. However, some studies have found that ESAs have some side effects; they can increase the risk of deep vein thrombosis and promote the progression of certain cancers. Therefore, ESAs should be fully evaluated before treatment, their indications should be strictly limited, and the appropriate indicators should be closely monitored during treatment.
3. Blood transfusion therapy: Some adverse reactions to blood transfusion may occur, so the indications should be mastered. Generally speaking, blood transfusion is needed when hemoglobin is lower than 7g/L. However, for elderly people with multiple underlying diseases, the indications for blood transfusion can be relaxed appropriately, such as hemoglobin lower than 80g/L can be considered for transfusion, so the decision of whether blood transfusion is needed depends on the cause of anemia of the patient. Patients with myelodysplastic syndrome and bone marrow hematopoietic dysfunction often have severe anemia and need to rely on blood transfusion for treatment, when attention should be paid to the diagnosis and treatment of iron overload.
4. Other treatment: For unexplained causes of anemia, if the anemia is mild it can be left untreated, and for moderate anemia erythropoietin can be tried for 2 months and discontinued promptly if there is no effect. There is evidence that vitamin D can reduce the release of inflammatory factors, so appropriate supplementation may help in the correction of anemia. There are also some new drugs being tested and not yet formally used in the clinic, which are believed to be used in the near future.
See also:
2. What Is Blood Test For Iron Called?
3. 2022 Best Home Hemoglobin Meter Buyers Guide
4. Can I take anemia tests at home?
5. How to choose the at-home kidney test？
6. What main factors influence the hemoglobin test for results?