Anemia in the elderly: introduction

Anaemia in elderly patients at discharge from intensive care and hospital

BACKGROUND AND OBJECTIVES

Anaemia is common in the elderly and is recognized as a risk factor for several adverse outcomes in older adults, including hospitalization, morbidity and mortality. The study aims were to examine the prevalence of anaemia in elderly patients at discharge from the intensive care unit (ICU) and hospital.

MATERIALS AND METHODS

Patient randomized under the INFORM trial and with an ICU admission were included. Two cohorts, Cohort 1 patients who were alive on discharge from ICU and Cohort 2 patients who were discharged alive from hospital to home. Prevalence of significant anaemia defined as haemoglobin levels, less than 100 g/l was measured at ICU and hospital discharge.

RESULTS

Overall, 76·5% (683/893) of elderly admissions in Cohort 1 had a haemoglobin <100 g/l, and 44·1% (395/893) had a haemoglobin <90 g/l on ICU discharge. Nadir haemoglobin during ICU stay, length of stay in ICU and transfusion during ICU stay was associated with significant anaemia at ICU discharge. At hospital discharge, in Cohort 2, 54·8% (263/480) of elderly ICU admissions had Hb < 100 g/l, and 23·4% (112/480) had Hb < 90 g/l. Male gender, haemoglobin level at ICU discharge, and length of stay and nadir Hb between ICU and hospital discharge were associated with anaemia at hospital discharge.

CONCLUSIONS

Significant anaemia is highly prevalent in elderly patients on discharge from ICU and to a lesser degree at hospital discharge.

Evaluation and management of anemia in the elderly

Anemia is now recognized as a risk factor for a number of adverse outcomes in the elderly, including hospitalization, morbidity, and mortality. What constitutes appropriate evaluation and management for an elderly patient with anemia, and when to initiate a referral to a hematologist, are significant issues. Attempts to identify suggested hemoglobin levels for blood transfusion therapy have been confounded for elderly patients with their co-morbidities. Since no specific recommended hemoglobin threshold has stood the test of time, prudent transfusion practices to maintain hemoglobin thresholds of 9-10 g/dL in the elderly are indicated, unless or until evidence emerges to indicate otherwise.

Age-related changes in peripheral blood counts in humans

Anaemia has become a common concern in geriatric health. Since its prevalence varies quite significantly among different groups depending on factors such as ethnicity, lifestyle or fitness, the appropriateness of the current WHO definition of anaemia in the elderly may be questioned. We evaluated peripheral blood parameters from 1,724 individuals (908 women aged 18-101 years and 816 men aged 18-96 years), who were treated at the University of Heidelberg Medical Center with no known haematological history. Patients with a known malignant haematological or oncological disease or with chronic infection or inflammation were excluded. Patients with disorders affecting the kidneys, thyroid or stomach, as well as patients with a bleeding history, haemolysis or who had been previously diagnosed with anaemia were excluded from the study. Average haemoglobin levels for men beyond the age of 70 and for women beyond the age of 80 were found to fulfill the WHO criteria for the diagnosis of anaemia. While in our cohort ∼20% of men and women between 60-69 years of age were by definition anaemic, these numbers steadily increased to 63% in females and 76% in males beyond the age of 90. Based on the results of our study and in accordance with the literature on this topic, we suggest age-adjusted criteria for the diagnosis of anaemia in the elderly in conjunction with a geriatric assessment.

Age-related changes in peripheral blood counts in humans

Anaemia has become a common concern in geriatric health. Since its prevalence varies quite significantly among different groups depending on factors such as ethnicity, lifestyle or fitness, the appropriateness of the current WHO definition of anaemia in the elderly may be questioned. We evaluated peripheral blood parameters from 1,724 individuals (908 women aged 18-101 years and 816 men aged 18-96 years), who were treated at the University of Heidelberg Medical Center with no known haematological history. Patients with a known malignant haematological or oncological disease or with chronic infection or inflammation were excluded. Patients with disorders affecting the kidneys, thyroid or stomach, as well as patients with a bleeding history, haemolysis or who had been previously diagnosed with anaemia were excluded from the study. Average haemoglobin levels for men beyond the age of 70 and for women beyond the age of 80 were found to fulfill the WHO criteria for the diagnosis of anaemia. While in our cohort ∼20% of men and women between 60-69 years of age were by definition anaemic, these numbers steadily increased to 63% in females and 76% in males beyond the age of 90. Based on the results of our study and in accordance with the literature on this topic, we suggest age-adjusted criteria for the diagnosis of anaemia in the elderly in conjunction with a geriatric assessment.