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O’Mahony D, Mabunda SA, Mntonintshi M, Iruedo J, Kaswa R, Blanco-Blanco E, Ogunsanwo B, Namugenyi KAF, Vasaikar S, Yogeswaran P. Causes of Moderate and Severe Anaemia in a High-HIV and TB-Prevalent Adult Population in the Eastern Cape Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3584. [PMID: 36834279 PMCID: PMC9966846 DOI: 10.3390/ijerph20043584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Anaemia affects one in four adults in South Africa, with a higher prevalence in persons with HIV and tuberculosis. The aim of this study is to characterise the causes of anaemia in primary care and a district hospital setting. METHODS A cross-sectional study design investigated a purposive sample of adult males and non-pregnant females at two community health centres and a hospital casualty and outpatients. Fingerpick blood haemoglobin was measured with HemoCueHb201+. Those with moderate and severe anaemia underwent clinical examination and laboratory tests. RESULTS Of 1327 patients screened, median age was 48 years, and 63.5% were female. Of 471 (35.5%) with moderate and severe anaemia on HemoCue, 55.2% had HIV, 16.6% tuberculosis, 5.9% chronic kidney disease, 2.6% cancer, and 1.3% heart failure. Laboratory testing confirmed 227 (48.2%) with moderate and 111 (23.6%) with severe anaemia, of whom 72.3% had anaemia of inflammation, 26.5% iron-deficiency anaemia, 6.1% folate deficiency, and 2.5% vitamin B12 deficiency. Overall, 57.5% had two or more causes of anaemia. Multivariate modelling showed that patients with severe anaemia were three times more likely to have tuberculosis (OR = 3.1, 95% CI = 1.5-6.5; p-value = 0.002). Microcytosis was present in 40.5% with iron deficiency, macrocytosis in 22.2% with folate deficiency, and 33.3% with vitamin B12 deficiency. The sensitivities of the reticulocyte haemoglobin content and % hypochromic red blood cells in diagnosing iron deficiency were 34.7% and 29.7%, respectively. CONCLUSIONS HIV, iron deficiency, and tuberculosis were the most prevalent causes of moderate and severe anaemia. The majority had multiple causes. Iron, folate, and vitamin B12 deficiencies should be identified by biochemical testing rather than by red cell volume.
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Affiliation(s)
- Don O’Mahony
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Sikhumbuzo A. Mabunda
- School of Population Health, University of New South Wales, Sydney 2052, Australia
- George Institute for Global Health, University of New South Wales, Sydney 2042, Australia
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Mbulelo Mntonintshi
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Joshua Iruedo
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Ernesto Blanco-Blanco
- Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha 5100, South Africa
| | - Basil Ogunsanwo
- Department of Surgery, Walter Sisulu University, Mthatha 5117, South Africa
| | | | - Sandeep Vasaikar
- Department of Microbiology, Walter Sisulu University, Mthatha 5117, South Africa
| | - Parimalaranie Yogeswaran
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
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Alsaeed M, Ahmed SS, Seyadi K, Ahmed AJ, Alawi AS, Abulsaad K. The prevalence and impact of anemia in hospitalized older adults: A single center experience from Bahrain. J Taibah Univ Med Sci 2022; 17:587-595. [PMID: 35983439 PMCID: PMC9356376 DOI: 10.1016/j.jtumed.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/29/2021] [Accepted: 02/04/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study reports the prevalence of anemia and investigates its associated correlates and outcomes among elderly hospitalized patients in a single hospital in Bahrain. Methods A retrospective study was conducted on 227 consecutive elderly patients admitted under general internal medicine in the biggest tertiary hospital in Bahrain. Medical records were reviewed for all patients, including clinical characteristics, laboratory results, and outcomes. Results Anemia was highly prevalent among hospitalized elderly patients (71.6%). Males were significantly more affected than females (p = 0.031). In terms of severity, the most common type was moderate anemia (56.1%); with regards to etiology, the most common type was anemia associated with chronic disease (48.1%). Anemia was as common as other comorbidities, including hypertension (71.4%) and diabetes mellitus (53.7%). When comparing anemic to non-anemic patients, the length of hospital stay was significantly longer (p < 0.001) and inversely correlated to the level of hemoglobin; furthermore, 1-year mortality was significantly higher (p < 0.001). When compared to those with mild anemia, patients with moderate/severe anemia were more likely to die (odds ratio [OR] = 2.2, 95% confidence interval [CI]: 1.27-4.92). Conclusion The prevalence of anemia in our study was higher than previously reported. Even so, anemia receives minimal attention and is usually seen as a minor problem. Our results reiterate the need to recognize the high importance of anemia especially when diagnosing and treating older patients. This, in turn, could positively affect a number of outcomes such as mortality, length of stay, and the functional decline of admitted individuals.
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Affiliation(s)
- Mahmood Alsaeed
- Internal Medicine Department, Salmaniya Medical Complex, Manama, Bahrain
| | - Suha S. Ahmed
- Internal Medicine Department, Salmaniya Medical Complex, Manama, Bahrain
| | - Khalid Seyadi
- Internal Medicine Department, Salmaniya Medical Complex, Manama, Bahrain
| | - Abdulla J. Ahmed
- Internal Medicine Department, Salmaniya Medical Complex, Manama, Bahrain
| | - Ahmed S. Alawi
- Internal Medicine Department, Salmaniya Medical Complex, Manama, Bahrain
| | - Khalid Abulsaad
- Internal Medicine Department, Salmaniya Medical Complex, Manama, Bahrain
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Schop A, Stouten K, Riedl JA, van Houten RJ, Leening MJG, Bindels PJE, Levin MD. The accuracy of mean corpuscular volume guided anaemia classification in primary care. Fam Pract 2021; 38:735-739. [PMID: 34345918 DOI: 10.1093/fampra/cmab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anemia can be categorized into micro-, normo- or macrocytic anemia based on the mean corpuscular volume (MCV). This categorization might help to define the etiology of anemia. METHODS The cohort consisted of patients newly diagnosed with anaemia in primary care. Seven aetiologies of anaemia were defined, based on an extensive laboratory protocol. Two assumptions were tested: (i) MCV <80 fl (microcytic) excludes vitamin B12 deficiency, folic acid deficiency, suspected haemolysis and suspected bone marrow disease as anaemia aetiology. (ii) MCV >100 fl (macrocytic) excludes iron deficiency anaemia, anaemia of chronic disease and renal anaemia as anaemia aetiology. RESULTS Data of 4129 patients were analysed. One anaemia aetiology could be assigned to 2422 (59%) patients, more than one anaemia aetiology to 888 (22%) patients and uncertainty regarding the aetiology remained in 819 (20%) patients. MCV values were within the normal range in 3505 patients (85%). In 59 of 365 microcytic patients (16%), the anaemia aetiology was not in accordance with the first assumption. In 233 of 259 macrocytic patients (90%), the anaemia aetiology was not in accordance with the second assumption. CONCLUSIONS Anaemia aetiologies might be ruled out incorrectly if MCV guided classification is used as a first step in the diagnostic work-up of anaemia. We recommend using a broader set of laboratory tests, independent of MCV.
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Affiliation(s)
- Annemarie Schop
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Karlijn Stouten
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Jürgen A Riedl
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Ron J van Houten
- General Medical Practice van Houten, Hendrik-Ido-Ambacht, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology and Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Chamba C, Nasser A, Mawalla WF, Masamu U, Budodi Lubuva N, Tebuka E, Magesa P. Anaemia in the Hospitalized Elderly in Tanzania: Prevalence, Severity, and Micronutrient Deficiency Status. Anemia 2021; 2021:9523836. [PMID: 33728063 PMCID: PMC7935608 DOI: 10.1155/2021/9523836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/12/2020] [Accepted: 02/19/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Anaemia is a common problem in sub-Saharan Africa. While most literature has focused on children, women of childbearing age, and pregnant women, data for the elderly population are relatively scarce. Anaemia exhorts negative consequences to functional ability of elderly patients, both physically and cognitively. The purpose of this study was to determine the prevalence of anaemia, severity, and micronutrient deficiency status in the elderly hospitalized patients in Tanzania. METHODS A total of 156 hospitalized adults aged 60 years and above were enrolled in this study. A structured questionnaire was used to capture sociodemographic and clinical characteristics. Blood samples were collected, and a complete blood count, serum cobalamin, serum ferritin, and serum folate levels were measured to assess anaemia and micronutrient deficiency status in all participants who had anaemia. RESULTS The prevalence of anaemia was 79.5% (124/156) with severe anaemia in 33.9% (42/124) of participants, moderate anaemia in 42.7% (53/124) of participants, and 23.4% (29/124) of all participants had mild anaemia. Micronutrient deficiency was found in 14.5% (18/124) of all participants with anaemia. Combined deficiency (either iron and vitamin B12 deficiency or iron and folate deficiency) was the most common micronutrient deficiency anaemia with a frequency of 33.3% (6/18), followed by isolated iron and folate deficiencies at equal frequency of 27.8% (5/18) and vitamin B12 deficiency at 11.1% (2/18). CONCLUSION The prevalence of anaemia in the hospitalized elderly population is high warranting public health attention and mostly present in moderate and severe forms. Micro-nutrient deficiency anaemia is common in this age group and is mostly due to combined micronutrient deficiency.
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Affiliation(s)
- Clara Chamba
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-salam, Tanzania
| | - Ahlam Nasser
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-salam, Tanzania
| | - William F. Mawalla
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-salam, Tanzania
| | - Upendo Masamu
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-salam, Tanzania
| | - Neema Budodi Lubuva
- Department of Internal Medicine, Muhimbili National Hospital (MNH), Dar-es-salaam, Tanzania
| | - Erius Tebuka
- Department of Pathology, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania
| | - Pius Magesa
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-salam, Tanzania
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Schop A, Stouten K, Riedl JA, van Houten RJ, Leening MJG, van Rosmalen J, Bindels PJE, Levin MD. A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices. BMC FAMILY PRACTICE 2020; 21:167. [PMID: 32799818 PMCID: PMC7429725 DOI: 10.1186/s12875-020-01241-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022]
Abstract
Background To study etiologies of anemia using an extensive laboratory analysis in general practices. Method An extensive laboratory analysis was performed in blood of newly diagnosed anemia patients aged ≥50 years from the general population in the city of Dordrecht area, the Netherlands. Eight laboratory-orientated etiologies of anemia were defined. Patients were assigned one or more of these etiologies on the basis of their test results. Results Blood of 4152 patients (median age 75 years; 49% male) was analyzed. The anemia etiology was unclear in 20%; a single etiology was established in 59%; and multiple etiologies in 22% of the patients. The most common etiologies were anemia of chronic disease (ACD) (54.5%), iron deficiency anemia (IDA) (19.1%) and renal anemia (13.8%). The most common single etiologies were IDA (82%) and ACD (68%), while the multiple etiologies most commonly included folic acid deficiency (94%) and suspected bone marrow disease (88%). Older age was associated with a lower incidence of IDA and a higher incidence of renal anemia. Mild anemia was more often associated with ACD and uncertain anemia, while severe anemia was mainly seen in patients with IDA. Conclusion Extensive laboratory analysis in anemic patients from the general population helped clarify the etiology of anemia and revealed many various combinations of etiologies in a significant proportion of patients. Age, sex and the severity of anemia are predictive of the underlying etiology.
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Affiliation(s)
- A Schop
- Department of Internal Medicine, Albert Schweitzer Hospital, Postbus 444, 3300, AK, Dordrecht, the Netherlands.
| | - K Stouten
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - J A Riedl
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - R J van Houten
- General practice van Houten, Hendrik-Ido-Ambacht, the Netherlands
| | - M J G Leening
- Departments of Epidemiology and Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
| | - P J E Bindels
- Department of General Practice, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M-D Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Postbus 444, 3300, AK, Dordrecht, the Netherlands
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Ketz F, Buisson A, Velentza A, Pautas É. [Intravenous iron supplementation in the elderly patient]. SOINS. GÉRONTOLOGIE 2020; 25:44-46. [PMID: 32444083 DOI: 10.1016/j.sger.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Iron deficiency, absolute or functional, is a common pathology in elderly patients and the way of iron replacement therapy is a recurrent issue. It seems to be necessary to treat by intravenous iron instead of oral therapy because of defective iron absorption or side effects. Depending on the molecule chosen, the modes of administration, whether dilution, dose or rhythm, vary. The major risk of intravenous iron replacement is anaphylaxis, which is very rare, this is why it has to be an hospital administration.
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Affiliation(s)
- Flora Ketz
- Service de gériatrie aiguë polyvalente, Hôpital Charles-Foix, Groupe hospitalier AP-HP-Sorbonne Université, 7 avenue de la République, 94200 Ivry-sur-Seine, France; UFR médecine, Paris-Sorbonne université, 91-105 boulevard de l'Hôpital, 75013 Paris, France.
| | - Anne Buisson
- Service de gériatrie aiguë polyvalente, Hôpital Charles-Foix, Groupe hospitalier AP-HP-Sorbonne Université, 7 avenue de la République, 94200 Ivry-sur-Seine, France; UFR médecine, Paris-Sorbonne université, 91-105 boulevard de l'Hôpital, 75013 Paris, France
| | - Athanasia Velentza
- Service de gériatrie aiguë polyvalente, Hôpital Charles-Foix, Groupe hospitalier AP-HP-Sorbonne Université, 7 avenue de la République, 94200 Ivry-sur-Seine, France
| | - Éric Pautas
- Service de gériatrie aiguë polyvalente, Hôpital Charles-Foix, Groupe hospitalier AP-HP-Sorbonne Université, 7 avenue de la République, 94200 Ivry-sur-Seine, France; UFR médecine, Paris-Sorbonne université, 91-105 boulevard de l'Hôpital, 75013 Paris, France
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7
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Sympathetic nervous activity and hemoglobin levels in de novo Parkinson’s disease. Clin Auton Res 2020; 30:273-278. [DOI: 10.1007/s10286-020-00668-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/17/2020] [Indexed: 12/13/2022]
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Abstract
The objective of this narrative review was to provide an update on oral and nasal vitamin B12 (cobalamin) therapy in elderly patients. Relevant articles were identified by 'PubMed' and 'Scholar Google' search from January 2010 to July 2018 and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the 'Cochrane Library' and the 'ISI Web of Knowledge'. Data retrieved from international meetings were also used, as was information retrieved from commercial sites on the web and data from 'CARE B12' research group. For oral vitamin B12 therapy, four prospective randomized controlled trials, eight prospective studies, one systematic and four reviews fulfilled our inclusion criteria. The studies included mainly or exclusively elderly patients (≥65-year-olds). In all of the studies, the mean age of the patients was at least 70 years except for two. The present review documents that oral vitamin B12 replacement at 1000 μg daily proved adequate to cure vitamin B12 deficiency, with a good safety profile. The efficacy was particularly marked when considering the noticeable improvement in serum vitamin B12 levels and haematological parameters, such as haemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. For nasal vitamin B12, only a few preliminary studies were available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 injections in elderly patients. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.
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Affiliation(s)
- E Andrès
- Department of Internal Medicine, Diabetes and Metabolic Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - A-A Zulfiqar
- Department of Geriatrics, CHRU de Rouen, Rouen, France
| | - T Vogel
- Department of Geriatrics and Internal Medicine, Universitaires de Strasbourg, Strasbourg, France
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Busti F, Marchi G, Lira Zidanes A, Castagna A, Girelli D. Treatment options for anemia in the elderly. Transfus Apher Sci 2019; 58:416-421. [DOI: 10.1016/j.transci.2019.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Sharma D, Suri V, Pannu AK, Attri SV, Varma N, Kochhar R, Varma S, Kumari S. Patterns of geriatric anemia: A hospital-based observational study in North India. J Family Med Prim Care 2019; 8:976-980. [PMID: 31041236 PMCID: PMC6482803 DOI: 10.4103/jfmpc.jfmpc_450_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Geriatric anemia is a global health problem because of its high prevalence and associated significant morbidity and mortality. AIM The objectives of this study were to estimate the pattern of anemia in the elderly patients and the underlying etiology of anemia. RESEARCH DESIGN AND METHODS This was a hospital-based prospective observational study, conducted in patients aged 60 years and above at PGIMER, Chandigarh, a tertiary care center of North India. Anemia is defined as hemoglobin level less than 13 g/dl in men and 12 g/dl in women. RESULTS Among the 105 older patients with anemia, the mean value of hemoglobin was 8.8 ± 2.3 g/dl. The etiological distribution of anemia was iron deficiency in 26 patients (24.8%), chronic disease in 24 patients (22.9%), hematological disorders in 21 (20%), chronic kidney disease in 13 (12.4%), multifactorial in 8 (7.6%), vitamin B12 deficiency in 2 (1.9%), folate deficiency in 1 (0.9%), and hypothyroidism in 1 patient (0.9%). No etiology could be found in 9 patients (8.6%). 57.6% of the iron-deficient patients had upper gastrointestinal lesions and 30.7% had a nutritional cause. Common chronic diseases causing anemia were malignancy (36.6%) and liver disease (29.1%). The myelodysplastic syndrome was the commonest hematological disorder. 53.35% of the patients had normocytic anemia, 40% had microcytic anemia, and 6.6% had macrocytic anemia. CONCLUSIONS In most of the cases, anemia in the elderly had a treatable cause. Thus, a thorough investigation including gastrointestinal endoscopy is warranted. Unexplained progressive or unresponsive anemia requires bone marrow examination.
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Affiliation(s)
- Dheeraj Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Ashok K. Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Savita V. Attri
- Department of Paediatric Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Neelam Varma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Rakesh Kochhar
- Department of Adult Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Subhash Varma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Savita Kumari
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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Baseline hepcidin measurement in the differential diagnosis of anaemia for elderly patients and its correlation with the increment of transferrin saturation following an oral iron absorption test. ACTA ACUST UNITED AC 2018; 57:250-258. [DOI: 10.1515/cclm-2018-0551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/29/2018] [Indexed: 01/04/2023]
Abstract
Abstract
Background
Anaemia is often multifactorial in the elderly, with a frequent association between iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD). The primary objective of our study was to investigate whether baseline hepcidin measurement could be useful for identifying iron deficiency (ID) in anaemic elderly patients. The secondary objective was to assess whether baseline hepcidin concentrations correlated with the relative increase of transferrin saturation (TS) after an oral iron absorption test (OIAT).
Methods
Blood samples were collected between 7:30 am and 10:00 am in 328 geriatric outpatients, 102 underwent the OIAT. Types of anaemia were classified according biochemical and clinical criteria. TS and hepcidin were measured at baseline and 4 h after the iron dose. The ability of baseline hepcidin measurement to highlight ID in elderly anaemic patients was assessed using a receiver operator curve (ROC) analysis. Correlations between baseline hepcidin levels and the increment of TS following the OIAT were investigated using the Spearman coefficient.
Results
Among 328 included patients, 78 (23.8%) suffered from anaemia; 13 (4.0%), 19 (5.8%), 27 (8.2%) and 19 (5.8%) patients fulfilled criteria for IDA, IDA/ACD, ACD and unexplained anaemia, respectively. By multivariable analysis, creatinine, C-reactive protein, ferritin, Delta TS and Delta hepcidin were independently associated with baseline hepcidin concentrations. The area under the ROC curve (95% confidence interval) was 0.900 (0.830–0.970) for baseline hepcidin measurement. Baseline hepcidin levels correlated negatively with the relative increase in TS with a Spearman coefficient of −0.742.
Conclusions
Baseline hepcidin levels could be a useful tool to identify ID in anaemic elderly patients and may predict acute iron response following OIAT.
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Girelli D, Marchi G, Camaschella C. Anemia in the Elderly. Hemasphere 2018; 2:e40. [PMID: 31723768 PMCID: PMC6745992 DOI: 10.1097/hs9.0000000000000040] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 01/02/2023] Open
Abstract
Anemia affects a substantial fraction of the elderly population, representing a public health problem that is predicted to further increase in coming years because of the demographic drive. Being typically mild, it is falsely perceived as a minor problem, particularly in the elderly with multimorbidity, so that it often remains unrecognized and untreated. Indeed, mounting evidence indicates that anemia in the elderly (AE) is independently associated with disability and other major negative outcomes, including mortality. AE is generally multifactorial, but initial studies suggested that etiology remains unexplained in near one-third of cases. This proportion is consistently declining due to recent advances highlighting the role of several conditions including clonal hematopoiesis, "inflammaging," correctable androgen deficiency in men, and under-recognized iron deficiency. Starting from a real-world case vignette illustrating a paradigmatic example of anemia in an elderly patient with multimorbidity, we review the main clinical and pathophysiological aspect of AE, giving some practical insights into how to manage similar cases.
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Affiliation(s)
- Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Giacomo Marchi
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Clara Camaschella
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
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Schop A, Kip MMA, Stouten K, Dekker S, Riedl J, van Houten RJ, van Rosmalen J, Dinant GJ, IJzerman MJ, Koffijberg H, Bindels PJE, Kusters R, Levin MD. The effectiveness of a routine versus an extensive laboratory analysis in the diagnosis of anaemia in general practice. Ann Clin Biochem 2018; 55:535-542. [DOI: 10.1177/0004563217748680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background We investigated the percentage of patients diagnosed with the correct underlying cause of anaemia by general practitioners when using an extensive versus a routine laboratory work-up. Methods An online survey was distributed among 836 general practitioners. The survey consisted of six cases, selected from an existing cohort of anaemia patients ( n = 3325). In three cases, general practitioners were asked to select the laboratory tests for further diagnostic examination from a list of 14 parameters (i.e. routine work-up). In the other three cases, general practitioners were presented with all 14 laboratory test results available (i.e. extensive work-up). General practitioners were asked to determine the underlying cause of anaemia in all six cases based on the test results, and these answers were compared with the answers of an expert panel. Results A total of 139 general practitioners (partly) responded to the survey (17%). The general practitioners were able to determine the underlying cause of anaemia in 53% of cases based on the routine work-up, whereas 62% of cases could be diagnosed using an extensive work-up ( P = 0.007). In addition, the probability of a correct diagnosis decreased with the patient’s age and was also affected by the underlying cause itself, with anaemia of chronic disease being hardest to diagnose ( P = 0.003). Conclusion The use of an extensive laboratory work-up in patients with newly diagnosed anaemia is expected to increase the percentage of correct underlying causes established by general practitioners. Since the underlying cause can still not be established in 31.3% of anaemia patients, further research is necessary.
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Affiliation(s)
- Annemarie Schop
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Michelle MA Kip
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Karlijn Stouten
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Soraya Dekker
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Jurgen Riedl
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Ron J van Houten
- General Medical Practice van Houten, Hendrik-Ido-Ambacht, the Netherlands
| | | | - Geert-Jan Dinant
- Department of General Practice, Caphri School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | | | - Ron Kusters
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
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Fonseca C, Araújo M, Moniz P, Marques F, Araújo I, Costa L, Rodrigues J, Frade L, Botella A, Jesus S, Leitão A, Campos L. Prevalence and prognostic impact of anemia and iron deficiency in patients hospitalized in an internal medicine ward: The PRO-IRON study. Eur J Haematol 2017; 99:505-513. [DOI: 10.1111/ejh.12963] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Cândida Fonseca
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
- NOVA Medical School; Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisboa Portugal
| | - Manuel Araújo
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
| | - Patrícia Moniz
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
| | - Filipa Marques
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
- NOVA Medical School; Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisboa Portugal
| | - Inês Araújo
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
- NOVA Medical School; Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisboa Portugal
| | - Luís Costa
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
| | - Joana Rodrigues
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
| | - Luciana Frade
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
| | - Arturo Botella
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
- NOVA Medical School; Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisboa Portugal
| | - Susana Jesus
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
- NOVA Medical School; Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisboa Portugal
| | - Ana Leitão
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
- NOVA Medical School; Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisboa Portugal
| | - Luís Campos
- Internal Medicine III Ward; Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental (CHLO); Lisboa Portugal
- NOVA Medical School; Faculdade de Ciências Médicas; Universidade Nova de Lisboa; Lisboa Portugal
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15
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Prognostic impact of anemia and iron-deficiency anemia in a contemporary cohort of patients undergoing transcatheter aortic valve implantation. Int J Cardiol 2017. [DOI: 10.1016/j.ijcard.2017.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Riva E, Colombo R, Moreo G, Mandelli S, Franchi C, Pasina L, Tettamanti M, Lucca U, Mannucci PM, Nobili A. Prognostic value of degree and types of anaemia on clinical outcomes for hospitalised older patients. Arch Gerontol Geriatr 2016; 69:21-30. [PMID: 27875713 DOI: 10.1016/j.archger.2016.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE This study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge. METHODS A prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0-11.9g/dL in women; 10.0-12.9g/dL in men) and group 3 with moderately-severely reduced Hb (<10g/dL in women and men). RESULTS Patients (2678; mean age 79.2±7.4y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR=1.62; 95%CI 1.21-2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR=1.82;95%CI 1.25-2.67; group 3: OR=2.78;95%CI 1.82-4.26) and discharge (group 2: OR=2.37;95%CI 1.48-3.93; group 3: OR=3.70;95%CI 2.14-6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes. CONCLUSIONS Mild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia.
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Affiliation(s)
- Emma Riva
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Riccardo Colombo
- Medicine Intensive Care and Accident & Emergency Department, Niguarda Hospital, Milan, Italy
| | - Guido Moreo
- Internal Medicine Unit, San Carlo Clinic, Paderno Dugnano Milan, Italy
| | - Sara Mandelli
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Carlotta Franchi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Luca Pasina
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mauro Tettamanti
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Ugo Lucca
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Centre, IRCCS Ca' Granda Maggiore Hospital Foundation and University of Milan, Italy
| | - Alessandro Nobili
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
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17
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Prevalence of anemia and malnutrition and their association in elderly nursing home residents. Aging Clin Exp Res 2016; 28:857-62. [PMID: 26572155 DOI: 10.1007/s40520-015-0490-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/27/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Malnutrition is one of the most important geriatric syndromes in the elderly. The aim of this study was to investigate the association between anemia and malnutrition in elderly nursing home residents. MATERIALS AND METHODS Local nursing home residents over 60 years old in the Izmir were included in the study. Blood samples were taken from study participants for hemogram, iron, ferritin, total iron-binding capacity, vitamin B12 and folic acid analysis. WHO criteria were used to define anemia. Causes of anemia were classified as iron deficiency, vitamin B12 or folic acid deficiency, anemia of chronic disease or other hematologic causes. Anemia was defined as the dependent variable and malnutrition was defined as the independent variable. Correlation between MNA scores and Hb levels was determined using Pearson correlation analysis. The slope of causality between malnutrition and anemia was determined using the χ (2) test and logistic regression analysis. RESULTS The study included 257 elderly nursing home residents with a mean age of 78.5 ± 7.8 years. The overall prevalence of anemia was 54.9 %; 35.8 % of the study participants were at risk of malnutrition and 8.2 % were malnourished. Anemia risk was 2.12-fold higher in participants at risk of malnutrition and 5.05-fold higher in those with malnutrition. In the participants with malnutrition or malnutrition risk, the most common cause of anemia was anemia of chronic disease (57.1 and 46.5 %, respectively). CONCLUSION The prevalence of anemia among elderly nursing home residents is high in Turkey. Malnutrition and malnutrition risk increase the incidence of anemia.
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Risch M, Meier DW, Sakem B, Medina Escobar P, Risch C, Nydegger U, Risch L. Vitamin B12 and folate levels in healthy Swiss senior citizens: a prospective study evaluating reference intervals and decision limits. BMC Geriatr 2015; 15:82. [PMID: 26163013 PMCID: PMC4499201 DOI: 10.1186/s12877-015-0060-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/22/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The vitamin B12 and folate status in nonanaemic healthy older persons needs attention the more so as decrease in levels may be anticipated from reduced haematinic provision and/or impaired intestinal uptake. METHODS A total of 1143 subjectively healthy Swiss midlands participants (637 females and 506 males), ≥60 years of age were included in this study. Levels of vitamin B12, holotranscobalamin (holoTC), methylmalonic acid (MMA), homocysteine (Hcy), serum folate, red blood cell (RBC) folate were measured. Further, Fedosov's wellness score was determined. Associations of age, gender, and cystatin C/creatinine-based estimated kidney function, with the investigated parameters were assessed. Reference intervals were calculated. Further, ROC analysis was done to assess accuracy of the individual parameters in recognizing a deficient vitamin B12 status. Finally, decision limits for sensitive, specific and optimal recognition of vitamin B12 status with individual parameters were derived. RESULTS Three age groups: 60-69, 70-79 and ≥ 80 had median B12 (pmol/L) levels of 237, 228 and 231 respectively (p = 0.22), holoTC (pmol/L) of 52, 546 and 52 (p = 0.60) but Hcy (μmol/L) 12, 15 and 16 (p < 0.001), MMA (nmol/L) 207, 221 and 244 (p < 0.001). Hcy and MMA (both p < 0.001), but not holoTC (p = 0.12) and vitamin B12 (p = 0.44) were found to be affected by kidney function. In a linear regression model Fedosov's wellness score was independently associated with kidney function (p < 0.001) but not with age. Total serum folate and red blood cell (RBC) folate drift apart with increasing age: whereas the former decreases (p = 0.01) RBC folate remains in the same bandwidth across all age groups (p = 0.12) A common reference interval combining age and gender strata can be obtained for vitamin B12 and holoTC, whereas a more differentiated approach seems warranted for serum folate and RBC folate. CONCLUSION Whereas the vitamin B12 and holoTC levels remain steady after 60 years of age, we observed a significant increment in MMA levels accompanied by increments in Hcy; this is better explained by age-related reduced kidney function than by vitamin B12 insufficiency. Total serum folate levels but not RBC folate levels decreased with progressing age.
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Affiliation(s)
- Martin Risch
- Kantonsspital Graubünden, Zentrallabor, Loësstrasse 170, Chur, 7000, Switzerland.
| | - Dominik W Meier
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, Liebefeld, 3097, Switzerland.
| | - Benjamin Sakem
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, Liebefeld, 3097, Switzerland.
| | - Pedro Medina Escobar
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, Liebefeld, 3097, Switzerland.
| | - Corina Risch
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, Liebefeld, 3097, Switzerland.
| | - Urs Nydegger
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, Liebefeld, 3097, Switzerland.
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, Liebefeld, 3097, Switzerland. .,Private University Triesen, Triesen, 9495, Liechtenstein.
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Efficacy and Safety of Intravenous Ferric Carboxymaltose in Geriatric Inpatients at a German Tertiary University Teaching Hospital: A Retrospective Observational Cohort Study of Clinical Practice. Anemia 2015; 2015:647930. [PMID: 26236500 PMCID: PMC4506836 DOI: 10.1155/2015/647930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 06/07/2015] [Accepted: 06/17/2015] [Indexed: 02/07/2023] Open
Abstract
Current iron supplementation practice in geriatric patients is erratic and lacks evidence-based recommendations. Despite potential benefits in this population, intravenous iron supplementation is often withheld due to concerns regarding pharmacy expense, perceived safety issues, and doubts regarding efficacy in elderly patients. This retrospective, observational cohort study aimed to evaluate the safety and efficacy of intravenous ferric carboxymaltose (FCM, Ferinject) in patients aged >75 years with iron deficiency anaemia (IDA). Within a twelve-month data extraction period, the charts of 405 hospitalised patients aged 65–101 years were retrospectively analysed for IDA, defined according to WHO criteria for anaemia (haemoglobin: <13.0 g/dL (m)/<12.0 g/dL (f)) in conjunction with transferrin saturation <20%. Of 128 IDA patients screened, 51 (39.8%) received intravenous iron. 38 patient charts were analysed. Mean cumulative dose of intravenous FCM was 784.4 ± 271.7 mg iron (1–3 infusions). 18 patients (47%) fulfilled treatment response criteria (≥1.0 g/dL increase in haemoglobin between baseline and hospital discharge). AEs were mild/moderate, most commonly transient increases of liver enzymes (n = 5/13.2%). AE incidence was comparable with that observed in patients <75 years. No serious AEs were observed. Ferric carboxymaltose was well tolerated and effective for correction of Hb levels and iron stores in this cohort of IDA patients aged over 75 years.
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Romero-Ruperto S, Pérez-Bocanegra MC, Duran-Taberna M, Toscano-Rivera A, Barbé-Gil Ortega J, San José-Laporte A. [Anemia in elderly patients admitted to an acute geriatric ward]. Rev Esp Geriatr Gerontol 2015; 50:122-125. [PMID: 25749584 DOI: 10.1016/j.regg.2014.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 08/05/2014] [Accepted: 09/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe the characteristics, prevalence and prognostic of anemia in older patients admitted to an acute geriatric unit. MATERIAL AND METHODS A prospective descriptive study was conducted on patients admitted to a geriatric unit. Anemia was defined using the World Health Organization criteria. A comprehensive geriatric assessment was performed on all patients. When possible, a telephone follow-up re-evaluation (mortality, functional status) was performed one year after discharge. RESULTS A total of 145 patients were studied. The mean age was 81 years, and 93 (64.13%) were anemic. Chronic diseases and iron deficiency anemia were the most frequent. Anemic patients had lower scores in the Barthel Index (P<.05). The mortality one year after discharge was 47.9%, with no differences between anemic or non-anemic patients (OR 2.07, [0.98-4.4]). All the geriatric indexes (Barthel index; Charlson comorbidity index, Mini-mental state examination and Mini Nutritional Assessment) showed worse scores in patients who died one year after discharge. CONCLUSIONS The prevalence of anemia in the elderly admitted to a geriatric unit is elevated, and associated with a poorer functional status.
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Affiliation(s)
- Sheila Romero-Ruperto
- Servicio de Medicina Interna, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | | | | | - Ainhoa Toscano-Rivera
- Servicio de Medicina Interna, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - José Barbé-Gil Ortega
- Servicio de Medicina Interna, Hospital Universitario Vall d'Hebron, Barcelona, España
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MtDNA mutagenesis impairs elimination of mitochondria during erythroid maturation leading to enhanced erythrocyte destruction. Nat Commun 2015; 6:6494. [PMID: 25751021 DOI: 10.1038/ncomms7494] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 02/03/2015] [Indexed: 12/22/2022] Open
Abstract
Haematopoietic progenitor cells show special sensitivity to mitochondrial DNA (mtDNA) mutagenesis, which suggests that increased mtDNA mutagenesis could underlie anemias. Here we show that elevated mtDNA mutagenesis in mice with a proof-reading deficient mtDNA polymerase (PolG) leads to incomplete mitochondrial clearance, with asynchronized iron loading in erythroid precursors, and increased total and free cellular iron content. The resulting Fenton chemistry leads to oxidative damage and premature destruction of erythrocytes by splenic macrophages. Our data indicate that mitochondria actively contribute to their own elimination in reticulocytes and modulate iron loading. Asynchrony of this sequence of events causes severe mitochondrial anaemia by depleting the organism of red blood cells and the bone marrow of iron. Our findings account for the anaemia development in a progeroid mouse model and may have direct relevance to the anemias associated with human mitochondrial disease and ageing.
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22
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Joosten E, Lioen P. Iron deficiency anemia and anemia of chronic disease in geriatric hospitalized patients: How frequent are comorbidities as an additional explanation for the anemia? Geriatr Gerontol Int 2014; 15:931-5. [DOI: 10.1111/ggi.12371] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 01/07/2023]
Affiliation(s)
- Etienne Joosten
- Department of Internal Medicine; Division of Geriatric Medicine; University Hospitals Leuven; Leuven Belgium
| | - Pieter Lioen
- Department of Internal Medicine; Division of Geriatric Medicine; University Hospitals Leuven; Leuven Belgium
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Busti F, Campostrini N, Martinelli N, Girelli D. Iron deficiency in the elderly population, revisited in the hepcidin era. Front Pharmacol 2014; 5:83. [PMID: 24795637 PMCID: PMC4006029 DOI: 10.3389/fphar.2014.00083] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/04/2014] [Indexed: 12/13/2022] Open
Abstract
Iron deficiency (ID) is relatively common among the elderly population, contributing substantially to the high prevalence of anemia observed in the last decades of life, which in turn has important implications both on quality of life and on survival. In elderly subjects, ID is often multifactorial, i.e., due to multiple concurring causes, including inadequate dietary intake or absorption, occult bleeding, medications. Moreover, because of the typical multimorbidity of aged people, other conditions leading to anemia frequently coexist and make diagnosis of ID particularly challenging. Treatment of ID is also problematic in elderly, since response to oral iron is often slow, with a substantial fraction of patients showing refractoriness and requiring cumbersome intravenous administration. In the last decade, the discovery of the iron regulatory hormone hepcidin has revolutionized our understanding of iron pathophysiology. In this review, we revisit ID among elderly people in the light of the impressive recent advances on knowledge of iron regulation, and discuss how hepcidin may help in diagnosis and treatment of this common clinical condition.
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Geisel T, Martin J, Schulze B, Schaefer R, Bach M, Virgin G, Stein J. An etiologic profile of anemia in 405 geriatric patients. Anemia 2014; 2014:932486. [PMID: 24707396 PMCID: PMC3953485 DOI: 10.1155/2014/932486] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/14/2014] [Indexed: 12/13/2022] Open
Abstract
Background. Anemia is a common condition in the elderly and a significant risk factor for increased morbidity and mortality, reducing not only functional capacity and mobility but also quality of life. Currently, few data are available regarding anemia in hospitalized geriatric patients. Our retrospective study investigated epidemiology and causes of anemia in 405 hospitalized geriatric patients. Methods. Data analysis was performed using laboratory parameters determined during routine hospital admission procedures (hemoglobin, ferritin, transferrin saturation, C-reactive protein, vitamin B12, folic acid, and creatinine) in addition to medical history and demographics. Results. Anemia affected approximately two-thirds of subjects. Of 386 patients with recorded hemoglobin values, 66.3% were anemic according to WHO criteria, mostly (85.1%) in a mild form. Anemia was primarily due to iron deficiency (65%), frequently due to underlying chronic infection (62.1%), or of mixed etiology involving a combination of chronic disease and iron deficiency, with absolute iron deficiency playing a comparatively minor role. Conclusion. Greater awareness of anemia in the elderly is warranted due to its high prevalence and negative effect on outcomes, hospitalization duration, and mortality. Geriatric patients should be routinely screened for anemia and etiological causes of anemia individually assessed to allow timely initiation of appropriate therapy.
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Affiliation(s)
- Tabea Geisel
- Crohn Colitis Center Rhein-Main, 60594 Frankfurt/Main, Germany
- Institute of Nutritional Science, University of Giessen, 35392 Giessen, Germany
| | - Julia Martin
- Crohn Colitis Center Rhein-Main, 60594 Frankfurt/Main, Germany
- Institute of Nutritional Science, University of Giessen, 35392 Giessen, Germany
| | | | - Roland Schaefer
- Krankenhaus Sachsenhausen, Teaching Hospital of the J. W. von Goethe University Frankfurt/Main, 60594 Frankfurt/Main, Germany
| | - Matthias Bach
- St. Elisabethen Krankenhaus, 60487 Frankfurt/Main, Germany
| | - Garth Virgin
- Vifor Pharma Deutschland GmbH, 81379 Munich, Germany
| | - Jürgen Stein
- Crohn Colitis Center Rhein-Main, 60594 Frankfurt/Main, Germany
- Institute of Nutritional Science, University of Giessen, 35392 Giessen, Germany
- Department of Gastroenterology and Nutritional Medicine, Krankenhaus Sachsenhausen, Teaching Hospital of the J. W. von Goethe University Frankfurt/Main, 60594 Frankfurt/Main, Germany
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Sejima T, Morizane S, Yao A, Isoyama T, Saito M, Amisaki T, Koumi T, Takenaka A. Prognostic impact of preoperative hematological disorders and a risk stratification model in bladder cancer patients treated with radical cystectomy. Int J Urol 2013; 21:52-7. [DOI: 10.1111/iju.12161] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/10/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Takehiro Sejima
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
| | - Shuichi Morizane
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
| | - Akihisa Yao
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
| | - Tadahiro Isoyama
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
| | - Motoaki Saito
- Division of Molecular Pharmacology; Department of Pathophysiological and Therapeutic Science; Tottori University Faculty of Medicine; Yonago Japan
| | - Takashi Amisaki
- Department of Biological Regulation; Tottori University Faculty of Medicine; Yonago Japan
| | - Tsutomu Koumi
- Department of Urology; Matsue Red Cross Hospital; Matsue Japan
| | - Atsushi Takenaka
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
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26
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Andrès E, Federici L. Hypochromia, microcytosis and iron deficiency. Eur J Intern Med 2013; 24:e10. [PMID: 22917758 DOI: 10.1016/j.ejim.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jolobe OMP. Hypochromia is more prevalent than microcytosis in iron deficiency anaemia. Eur J Intern Med 2013; 24:e9. [PMID: 22980571 DOI: 10.1016/j.ejim.2012.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 05/10/2012] [Accepted: 05/16/2012] [Indexed: 12/01/2022]
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Andrès E, Serraj K, Federici L, Vogel T, Kaltenbach G. Anemia in elderly patients: New insight into an old disorder. Geriatr Gerontol Int 2012; 13:519-27. [DOI: 10.1111/ggi.12017] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 12/21/2022]
Affiliation(s)
| | - Khalid Serraj
- Department of Internal Medicine, Diabetes and Metabolic Disorders; University Hospital of Strasbourg; Strasbourg; France
| | - Laure Federici
- Department of Internal Medicine; University Hospital of Oujda; Oujda; Morocco
| | - Thomas Vogel
- Department of Geriatrics and Internal Medicine; University Hospital of Strasbourg; Strasbourg; France
| | - Georges Kaltenbach
- Department of Geriatrics and Internal Medicine; University Hospital of Strasbourg; Strasbourg; France
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