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Karismaz A, Pasin O, Kara O, Eren R, Smith L, Doventas A, Soysal P. Associations between anemia and dependence on basic and instrumental activities of daily living in older women. BMC Geriatr 2024; 24:741. [PMID: 39244584 PMCID: PMC11380193 DOI: 10.1186/s12877-024-05342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 08/28/2024] [Indexed: 09/09/2024] Open
Abstract
AIM The aim of the present study was to examine the relationship between anemia and basic and instrumental activities of daily living in older female patients. METHODS 540 older female outpatients were included in this cross-sectional study. Anemia was defined as a hemoglobin below 12 g/dL. Patients' demographic characteristics, comorbidities, Geriatric Depression Scale, Mini Nutritional Assessment, and Mini-Mental State Examination (MMSE) were also recorded. Handgrip strength (HGS) was measured with a hand dynamometer to detect dynapenia. Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functional capacity. RESULTS The mean age of the participants was 77.42 ± 7.42 years. The prevalence of patients with anemia was 35%. A significant difference was observed between anemic and non-anemic groups in terms of age, presence of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), chronic kidney disease (CKD), malnutrition, dynapenia, and MMSE, BADL and IADL scores (p < 0.05). In multivariate analysis, after adjustment for age, DM, hypertension, CAD and CKD; there were significant associations between anemia and reduced BADL/IADL scores, dynapenia, falls, the risk of falls, MMSE, and malnutrition (p < 0.05). After adjusting for all confounding variables, deterioration in total BADL and IADL total scores were still more common among anemic older females than those without anemia (p < 0.05). CONCLUSION One out of every three older women presenting at one outpatient clinic were anemic. Anemia was observed to be associated with dependence in both BADL and IADL measures. Therefore, the presence of anemia in elderly women should be routinely checked, and possible causes should be investigated and treated to improve their functional capacity.
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Affiliation(s)
- Abdulkadir Karismaz
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Ozge Pasin
- Department of Biostatistics, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Osman Kara
- Department of Hematology, Bahcesehir University Medical Park Goztepe Hospital, Istanbul, Turkey
| | - Rafet Eren
- Department of Hematology, Biruni University Faculty of Medicine, Biruni University Hospital, Istanbul, Turkey
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Alper Doventas
- Division of Geriatric Medicine, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Wondm SA, Dagnew SB, Gubae K, Tesfaye TC, Tamene FB. Determinants of anemia among patients receiving cancer chemotherapy in Northwest Ethiopia. Front Med (Lausanne) 2024; 11:1415877. [PMID: 39055698 PMCID: PMC11269183 DOI: 10.3389/fmed.2024.1415877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
Background Chemotherapy-induced anemia (CIA) is a hematologic complication that frequently affects patients with cancer undergoing chemotherapy. It is associated with worse treatment outcomes, higher rates of morbidity and mortality, worse quality of life, and higher healthcare costs. The incidence and predictors of CIA in Ethiopia, particularly in Northwest Ethiopian oncology centers, are poorly understood. This study was conducted at Northwest Ethiopian oncology centers to evaluate the incidence and determinants of chemotherapy-induced anemia in adult patients with cancer undergoing chemotherapy. Methods This 3-year hospital-based retrospective follow-up study included adult patients with cancer receiving chemotherapy between 2019 and 2021 at two oncology centers in Northwest Ethiopia. Data were collected from October to December 2021. A binary logistic regression model was used to select variables and determine the Crude Odds Ratio (COR). Variables with P-value < 0.2 were entered into the multivariable logistic regression and Adjusted odds ratio (AOR) with 95% Confidence intervals (CI) for variables with P-value < 0.05 were estimated to show determinants of chemotherapy-induced anemia among cancer patients who received chemotherapy. Results A total of 402 patients were included in the final analysis. The overall incidence of CIA was 75.4% (95% CI 70.7, 79.8). Older age [AOR = 1.8, 95% CI (1.4-3.5); P = 0.043], hematologic cancer [AOR = 3.7, 95% CI (3.2-5.7), P = 0.021], obesity [AOR = 3.4, 95% CI (2.3-6.9); P = 0.028], ≥6 chemotherapy cycles [AOR = 3.8, 95% CI (3.2-5.1), P = 0.019], cancer metastasis to bone [AOR = 2.9, 95% CI (1.2-4.7), P = 0.025] were statistically significant predictors of chemotherapy-induced anemia. Conclusion Chemotherapy-induced anemia persisted in a significant percentage of cancer patients. Chemotherapy-induced anemia developed in three-quarters of patients undergoing chemotherapy. Chemotherapy-induced anemia was significantly associated with older age, hematologic malignancy, obesity, a greater number of chemotherapy cycles, and cancer metastasis to bone. To lower the risk of morbidity related to anemia, patients with chemotherapy-induced anemia should be regularly evaluated and treated with appropriate treatment.
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Affiliation(s)
- Samuel Agegnew Wondm
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Samuel Berihun Dagnew
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kale Gubae
- Pharmacology Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tegenu Chanie Tesfaye
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fasil Bayafers Tamene
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Pencina KM, Travison TG, Artz AS, Lincoff AM, Nissen SE, Flevaris P, Chan A, Li X, Diegel SA, Wannemuehler K, Bhasin S. Efficacy of Testosterone Replacement Therapy in Correcting Anemia in Men With Hypogonadism: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2340030. [PMID: 37889486 PMCID: PMC10611996 DOI: 10.1001/jamanetworkopen.2023.40030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/08/2023] [Indexed: 10/28/2023] Open
Abstract
Importance Testosterone deficiency causes mild anemia. Whether testosterone replacement therapy (TRT) can correct anemia or prevent the development of anemia in men with hypogonadism remains incompletely understood. Objective To assess the efficacy of TRT in correcting anemia in men with hypogonadism and anemia, and reducing the risk of developing anemia in those without anemia. Design, Setting, and Participants This randomized, placebo-controlled trial included men with hypogonadism at 316 US sites enrolled between May 2018 and February 2022. This study was nested within the Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) Study, which evaluated the effect of TRT on major adverse cardiovascular events in middle-aged and older men with hypogonadism. Eligible participants were aged 45 to 80 years, with 2 testosterone concentration results below 300 ng/dL, hypogonadal symptoms, and cardiovascular disease (CVD) or increased CVD risk. The last study visit took place in January 2023. Data were analyzed between March and August 2023. Intervention Participants were randomized with stratification for preexisting CVD to 1.62% testosterone gel or placebo gel daily for the study duration. Main Outcomes and Measures Proportion of participants with anemia (hemoglobin below 12.7 g/dL) whose anemia remitted (hemoglobin 12.7 g/dL or above) over the study duration. Secondary end points included incidence of anemia among men who were not anemic. Binary end points were analyzed using repeated-measures log-binomial regression. Results A total of 5204 men were included, 815 with anemia (mean [SD] age, 64.8 [7.7] years; 247 Black [30.3%], 544 White [66.7%], 24 other [2.9%]) and 4379 without anemia (mean [SD] age, 63.0 [7.9] years; 629 Black [14.4%], 3603 White [82.3%], 147 other [3.4%]). Anemia corrected in a significantly greater proportion of testosterone-treated than placebo-treated men at 6 months (143 of 349 [41.0%] vs 103 of 375 [27.5%]), 12 months (152 of 338 [45.0%] vs 122 of 360 [33.9%]), 24 months (124 of 290 [42.8%] vs 95 of 307 [30.9%]), 36 months (94 of 216 [43.5%] vs 76 of 229 [33.2%]), and 48 months (41 of 92 [44.6%] vs 38 of 97 [39.2%]) (P = .002). Among participants without anemia, a significantly smaller proportion of testosterone-treated men developed anemia than placebo-treated men. Changes in hemoglobin were associated with changes in energy level. Conclusions and Relevance In middle-aged and older men with hypogonadism and anemia, TRT was more efficacious than placebo in correcting anemia. Among men who were not anemic, a smaller proportion of testosterone-treated men developed anemia than placebo-treated men. Trial Registration ClinicalTrials.gov Identifier: NCT03518034.
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Affiliation(s)
- Karol M. Pencina
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas G. Travison
- Marcus Institute for Aging Research, Hebrew Senior Life; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Andrew S. Artz
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - A. Michael Lincoff
- Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Steven E. Nissen
- Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Xue Li
- AbbVie Inc, North Chicago, Illinois
| | - Scott A. Diegel
- Department of Biostatistics and Medical Informatics, Statistical Data Analysis Center, University of Wisconsin, Madison
| | - Kathleen Wannemuehler
- Department of Biostatistics and Medical Informatics, Statistical Data Analysis Center, University of Wisconsin, Madison
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Association between anemia and dynapenia in older adults: a population-based study. Aging Clin Exp Res 2022; 34:1373-1379. [PMID: 35000139 DOI: 10.1007/s40520-021-02064-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few reports have been issued on the relationship between anemia and dynapenia in older people. AIM This study aimed to assess the independent association between anemia and dynapenia in older adults. METHODS This study was based on an analysis of the Korea National Health and Nutrition Examination Survey database (2015-2018). A total of 4812 subjects aged ≥ 65 years were included. Dynapenia was defined by a handgrip strength (HGS). The independent association between dynapenia and anemia was examined by complex-sample multivariable logistic regression analyses. RESULTS The geometric mean serum hemoglobin level for all study subjects was 13.73 g/dL, and the prevalence of anemia was 13.1% (men, 12.8%; women 13.4%). Anemic subjects had a significantly lower adjusted mean HGS than non-anemic controls (23.14 ± 0.45 kg vs. 24.50 ± 0.38 kg, P < 0.001). Furthermore, anemic subjects had a significantly higher odds ratio for dynapenia (OR, 1.68; 95% CI, 1.30-2.17) than subjects without anemia after adjusting for multiple confounders, and the odds ratio of dynapenia was higher for anemic men (OR, 2.06, 95% CI, 1.38-3.09). CONCLUSION This study indicates anemia is independently associated with dynapenia in older Koreans, especially in men, and indicates that dynapenia screening is needed in older people with anemia.
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Kara O, Smith L, Tan SG, Soysal P. The clinical implications and importance of anemia in older women. Acta Clin Belg 2022; 77:558-564. [PMID: 33825656 DOI: 10.1080/17843286.2021.1913388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objective of this study was to investigate associations between anemia with geriatric syndromes and comprehensive geriatric assessment (CGA) parameters in older women. METHODS 886 older outpatient women were included. Anemia was defined as a hemoglobin concentration below 12 g/dL. patients were divided into two groups as anemic and non-anemic. The relationships between anemia and CGA parameters/geriatric syndromes were determined. RESULTS The mean age of the participants was 76.00 ± 8.91. The prevalence of patients with anemia was 15.35%. There was a significant difference between anemic and non-anemic groups in terms of age, Charlson Comorbidity Index, body mass index, the number of drugs used, and the presence of chronic renal failure (p < 0.05). After adjustment for these covariates, anemia was associated with Timed Up and Go test (OR: 1.10, 95% CI: 1.02-1.18), muscle strength (OR: 0.99, 95% CI: 0.83-0.99), dynapenia (OR: 1.92, 95% CI: 1.06-3.47), Mini Nutritional Assessment scores (OR: 0.88, 95% CI: 0.83-0.94), poor nutritional status (OR: 1.97, 95% CI: 1.10-3.48), Fried scores (OR: 1.42, 95% CI: 1.24-1.68), frailty (OR: 2.58, 95% CI: 1.42-4.69), falls (OR: 1.78, 95% CI: 1.10-2.92) and polypharmacy (OR: 2.31, 95% CI: 1.38-3.86). CONCLUSION In the present study anemia was associated with frailty, polypharmacy, poor nutritional status, falls, and decreased muscle strength. Therefore, anemia may be a sign of poor health status in older women. When anemia is detected in an older woman, CGA should be strongly considered if not routinely performed.
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Affiliation(s)
- Osman Kara
- Department of Hematology, Bahcesehir University Medical Park Goztepe Hospital, Istanbul, Turkey
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Semen Gokce Tan
- Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
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Lee DT, Plesa ML. Anemia. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Causes of Anemia in Polish Older Population-Results from the PolSenior Study. Cells 2021; 10:cells10082167. [PMID: 34440936 PMCID: PMC8392520 DOI: 10.3390/cells10082167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022] Open
Abstract
Vitamin B12, folate, iron deficiency (IDA), chronic kidney disease (CKD), and anemia of inflammation (AI) are among the main causes of anemia in the elderly. WHO criteria of nutritional deficiencies neglect aging-related changes in absorption, metabolism, and utilization of nutrients. Age-specific criteria for the diagnosis of functional nutritional deficiency related to anemia are necessary. We examined the nationally representative sample of Polish seniors. Complete blood count, serum iron, ferritin, vitamin B12, folate, and renal parameters were assessed in 3452 (1632 women, 1820 men) participants aged above 64. Cut-off points for nutritional deficiencies were determined based on the WHO criteria (method-A), lower 2.5 percentile of the studied population (method-B), and receiver operating characteristic (ROC) analysis (method-C). Method-A leads to an overestimation of the prevalence of vitamin B12 and folate deficiency, while method-B to their underestimation with over 50% of unexplained anemia. Based on method-C, anemia was classified as nutritional in 55.9%. In 22.3% of cases, reasons for anemia remained unexplained, the other 21.8% were related to CKD or AI. Mild cases were less common in IDA, and more common in non-deficiency anemia. Serum folate had an insignificant impact on anemia. It is necessary to adopt the age-specific criteria for nutrient deficiency in an old population.
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Agravat AH, Pujara K, Kothari RK, Dhruva GA. A clinico-pathological study of geriatric anemias. Aging Med (Milton) 2021; 4:128-134. [PMID: 34250431 PMCID: PMC8251857 DOI: 10.1002/agm2.12150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Anemia in the older age (e.g., >60 years) is a major health problem in India and many parts of the world since it signifies an underlying disease and is associated with poor clinical outcome like increased morbidity and affects health-related quality of life. Since symptoms like fatigue or shortness of breath related to anemia could also be attributed to the aging process, anemia is often easily overlooked in the elderly. AIMS AND OBJECTIVES Clinico-hematological patterns and morphological types of anemia in older age (e.g. >60 years) are manifold, hence this study was undertaken to determine them and to know more about associated disorders. MATERIALS AND METHODOLOGY The present study was conducted on a sample size of 1257 patients who were 60 years and above and clinically diagnosed as anemic. Routine haematological investigations including peripheral blood smear examination and complete hemogram were done. Special investigations like bone-marrow examination and iron studies were done whenever required. RESULTS Males (aged >60 years) were more affected than females (aged >60 years) and patients in the age group of 60-69 years were affected the most. The most common presenting symptom was generalized weakness. The most common morphological type was normocytic normochromic anemia, and chronic diseases were the commonest etiological factors. CONCLUSION In spite of modern diagnostic advances, geriatric anemias still remain under-reported and inadequately investigated, necessitating evaluation of even mild anemias. Prompt diagnosis and definite categorization helps in appropriate management of anemias.
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Affiliation(s)
| | - Krupal Pujara
- Pandit Deendayal Upadhyay Medical CollegeRajkotIndia
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ŞENKAYA A, ÇELİK F, ÖZÜTEMİZ Ö. Endoscopic findings in the older patients with iron-deficiency anemia. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.915674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Li J, Feng L, Huang Q, Ren W. An L-Shaped Relationship Between Serum Iron and Stroke-Associated Pneumonia. Clin Interv Aging 2021; 16:505-511. [PMID: 33790545 PMCID: PMC7997604 DOI: 10.2147/cia.s301480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Pneumonia is a common complication in patients with stroke. There was a close relationship between serum iron and inflammatory response. This study aimed to explore the relationship between serum iron levels and stroke-associated pneumonia (SAP). Methods Patients with acute stroke were recruited from the First Affiliated Hospital of Wenzhou Medical University and divided into SAP group and Non-SAP group. The demographic and clinical data of the patients were collected via the medical records, and the blood samples were collected within 24 hours after admission. The predictive value of serum iron to SAP was evaluated by receiver operating characteristic curve (ROC) and binary Logistic regression models. A restricted cubic spline (RCS) was used to furtherly clarify the relationship between serum iron and the risk of SAP. Results A total of 906 participants were enrolled, including Non-SAP group (n = 755) and SAP group (n = 151). Serum iron levels in the SAP group were significantly lower than those in the Non-SAP group (9.77±5.61 vs 14.01±6.80, P < 0.001). Logistic regression showed that patients with high serum iron levels (≥7.8μmol/L) showed a lower risk of SAP (OR=0.43, 95% CI, 0.27–0.69, P < 0.001). Besides, the RCS model showed that there was an L-shaped relationship between the serum iron and risk of SAP (P for non-linearity: 0.014). Conclusion Low serum iron level was a risk factor for SAP, and there was an L-shaped relationship between them. Stroke patients with low serum iron levels should be alert to the risk of SAP.
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Affiliation(s)
- Jia Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Liang Feng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Qiqi Huang
- Department of Cardiac Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Wenwei Ren
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
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Chen C, Liu GG, Sun Y, Gu D, Zhang H, Yang H, Lu L, Zhao Y, Yao Y. Association between household fuel use and sleep quality in the oldest-old: Evidence from a propensity-score matched case-control study in Hainan, China. ENVIRONMENTAL RESEARCH 2020; 191:110229. [PMID: 32950513 DOI: 10.1016/j.envres.2020.110229] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
STUDY OBJECTIVES Emerging evidence has documented that poor sleep quality associated with adverse effects with physical, psychological and neurological disorders, which impeded healthy aging. There is limited knowledge regarding the association of household air pollution (HAP) from solid fuel use with sleep quality, particularly among the population at advanced ages. The aim of this study is to investigate this association in oldest-old (≥80 years) populations. METHODS China Hainan Centenarian Cohort Study was conducted in the 18 cities and counties of Hainan Province from 2015 to 2017. A total of 1725 individuals aged 80 years and older were included in the study. We used the Pittsburgh sleep quality index (PSQI) to measure individuals' sleep quality with a score of PSQI >8 indicating poor sleep quality. Solid fuel users were defined as those who primarily use coal, biomass charcoal, wood or straw for cooking in their daily life. The propensity score matching (PSM) was adopted and logistic regressions were performed based on the matched sample to estimate the association between the two factors. We adjusted for a wide range of covariates, including demographic, socioeconomic, health-related, and environmental factors. RESULTS After matching, a total of 1616 participants (mean [SD] age, 94.5 [9.5] years; 72.5% women) were included in the final analysis. About 50.9% of the participants used solid fuel for cooking. The average global PSQI score was 8.26 (SD = 3.3), 49.0% of them were detected as poor sleep quality with a global PSQI score >8. We found significantly higher risk of having poor sleep quality among those who were currently solid fuel users than among clean fuel users, with an odds ratio (OR) of 1.43 (95% CI: 1.14-1.80), adjusting for a wide range of confounders. The associations were more pronounced in those who did not use any ventilation (compared to those who used either mechanical or natural cooking ventilation; 1.79 [1.30-2.47] vs. 1.27 [1.01-1.53], P for interaction = 0.016) and in those who were frequent cooking at home (compared to those who never cooked; 1.65 [1.21-2.26] vs. 1.18 [0.93-1.40], P for interaction = 0.025). CONCLUSIONS Exposure to HAP from solid fuel combustion increases the risk of poor sleep quality at oldest-old ages. Our findings point to the need of reducing HAP from polluted fuel combustion and implementing cooking ventilation as a public health priority for healthy aging initiatives.
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Affiliation(s)
- Chen Chen
- School of Health Sciences, Wuhan University, Wuhan, 430071, China; National School of Development, Peking University, Beijing, 100871, China
| | - Gordon G Liu
- National School of Development, Peking University, Beijing, 100871, China
| | - Yankun Sun
- Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, 100191, China
| | - Danan Gu
- Independent researcher, New York, NY, 10017, USA
| | - Hao Zhang
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Huazhen Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Lin Lu
- Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, 100191, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572000, Hainan, China.
| | - Yao Yao
- National School of Development, Peking University, Beijing, 100871, China; Center for the Study of Aging and Human Development, Medical School of Duke University, Durham, NC, 27705, USA.
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Bani Hassan E, Vogrin S, Hernandez Viña I, Boersma D, Suriyaarachchi P, Duque G. Hemoglobin Levels are Low in Sarcopenic and Osteosarcopenic Older Persons. Calcif Tissue Int 2020; 107:135-142. [PMID: 32440760 DOI: 10.1007/s00223-020-00706-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022]
Abstract
Anemia is commonly associated with osteoporosis and sarcopenia in older persons. However, there is a common subset of patients identified as osteosarcopenic at a higher risk of adverse outcomes. Whether these patients are also at a higher risk of anemia remains unknown. In this study, we aimed to compare hemoglobin (Hb) levels in osteosarcopenic older subjects versus those with sarcopenia, osteopenia/osteoporosis alone and controls. Cross-sectional study in 558 community-dwelling participants older than 65 (mean age 79 ± 7.5 years) from Western Sydney, Australia. Associations of anemia with sarcopenia, osteopenia/osteoporosis and osteosarcopenia were assessed. Participants were able to mobilize independently, reported a risk/history of falls and were not cognitively impaired. We used the original (EWGOP) and revised (EWGSOP2) European consensus on definition of sarcopenia, and WHO definitions of osteoporosis and osteopenia. Based on both European definitions of sarcopenia prevalence of anemia was the highest among sarcopenic patients (39%), followed by osteosarcopenic (34%), osteoporotic/penic (26%), and controls (24%). Anemia prevalence in total was 176/553 (31.5%). Osteosarcopenic patients on average had 6.3 g/L lower Hb levels compared to controls (p = 0.001), and 3.7 g/L lower Hb than patients with osteoporosis/penia (p < 0.026). Interestingly, levels of Hb did not differ between sarcopenic vs osteosarcopenic patients (p = 0.817) and between osteoporotic/osteopenic patients vs controls (p > 0.259). The higher prevalence of anemia and lower hemoglobin in sarcopenic and osteosarcopenic subjects compared to osteoporotic/penic participants and controls was established. However, the previously reported associations between osteoporosis and anemia were not confirmed. A likely explanation can be inclusion of osteosarcopenic subjects as osteoporotic in previous studies.
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Affiliation(s)
- Ebrahim Bani Hassan
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Sunshine Hospital, L3 WCHRE Bldg, 176 Furlong Road, St Albans, VIC, 3021, Australia.
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia.
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Sunshine Hospital, L3 WCHRE Bldg, 176 Furlong Road, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
| | | | - Derek Boersma
- Falls and Fractures Clinic, Department of Geriatric Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Pushpa Suriyaarachchi
- Falls and Fractures Clinic, Department of Geriatric Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Sunshine Hospital, L3 WCHRE Bldg, 176 Furlong Road, St Albans, VIC, 3021, Australia.
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia.
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Polimeni A, Indolfi C. How should I treat elderly patients at high bleeding risk with acute coronary syndrome? J Cardiovasc Med (Hagerstown) 2020; 21:401-402. [DOI: 10.2459/jcm.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Anemia. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_132-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Michalak SS, Rupa-Matysek J, Hus I, Gil L. Unexplained anemia in the elderly - a real life analysis of 981 patients. Arch Med Sci 2020; 16:834-841. [PMID: 32542085 PMCID: PMC7286331 DOI: 10.5114/aoms.2019.82723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/06/2019] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
- Sylwia S. Michalak
- Department of Pharmacology and Toxicology, Faculty of Medicine and Health Science, University of Zielona Gora, Zielona Gora, Poland
- Corresponding author: Sylwia S. Michalak PhD, Department of Pharmacology and Toxicology, Faculty of Medicine and Health Science, University of Zielona Gora, 28 Zyty St, 65-046 Zielona Gora, Poland, Phone: +48 502 857 453, E-mail:
| | - Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Iwona Hus
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
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Raisinghani N, Kumar S, Acharya S, Gadegone A, Pai V. Does aging have an impact on hemoglobin? Study in elderly population at rural teaching hospital. J Family Med Prim Care 2019; 8:3345-3349. [PMID: 31742166 PMCID: PMC6857363 DOI: 10.4103/jfmpc.jfmpc_668_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/22/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The prevalence of anemia increases with age. Some serious underlying conditions may lead to anemia in the old age. The present study was undertaken to detect and do morphological typing of anemia and further delineate etiological factors in elderly patients. METHODS In this hospital-based prevalence study carried out a tertiary care center over one and half years, a total of 90 patients were fully evaluated for etiology and typing of anemia in elderly (>60 years age) patients. Details of other significant medical and surgical history were noted. Laboratory investigations were conducted, which included complete hemogram, peripheral blood smear, reticulocyte count, erythrocyte sedimentation rate estimation, serum urea, serum creatinine and serum lactate dehydrogenase, bone marrow examination (with Prussian blue marrow iron staining), serum iron and serum total iron-binding capacity, serum ferritin, and stool and urine examination. RESULTS The mean hemoglobin as per age was 60-64 years- 5.95 gm%, 65-69 years - 6.7 gm%, 70-74 years - 6.58 gm%, and 75-79 years - 6.87 gm%. The difference not being significant (p = 0.33). Morphologically, 53 patients (24 males and 29 females) had microcytic anemia, 27 (17 males and 10 females) had normocytic anemia, and 10 (8 males and 2 females) had macrocytic anemia. Anemia of chronic disease (ACD) was the most common occurrence (50, 55.56%), followed by iron deficiency anemia (IDA) (27, 30%), macrocytic anemia (9, 10%), and others 4 (4.44%). The cause of anemia was found in 10 out of 27 (37.03%) patients in the IDA group, 28 out of 50 (56%) in the ACD group, whereas the etiology was discernible in only one out of nine cases (11.1%) of macrocytic anemias. CONCLUSION There was no significant difference observed in the mean hemoglobin levels as the age increased. Morphologically, the majority of the patients had microcytic anemia, followed by normocytic anemia. A population-based study is recommended for further assessment of the prevalence and causes of anemias in asymptomatic elderly subjects.
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Affiliation(s)
- Nitin Raisinghani
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Aditi Gadegone
- Opthalamology Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Vinay Pai
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
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18
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Wee YH, Anpalahan M. The Role of Older Age in Normocytic Anaemia in Type 2 Diabetes Mellitus. Curr Aging Sci 2019; 12:76-83. [PMID: 31244445 DOI: 10.2174/1874609812666190627154316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Older age has a significant association with anaemia. However, this has not been adequately investigated in the context of specific comorbidities such as Type 2 Diabetes Mellitus (T2DM). OBJECTIVES To investigate the role of age in Normocytic Anaemia (NCA) and the adverse outcomes of NCA in T2DM. METHODS Patients with NCA, either unexplained or related to Chronic Kidney Disease (CKD), were recruited from a diabetic clinic over six months. Anaemia was defined as a haemoglobin(Hb) < 130g/l for men and <120g/l for women. The relevant data were obtained by interviewing patients and review of medical records. Patients were followed for 12 months for pre-defined adverse outcomes. RESULTS Of the 354 patients assessed, 203 were included (mean age 63.12 ± 13.62 years, males 49.8%). The prevalence of NCA was 24% (49). Older age had a significant univariate association with NCA (p < 0.001) and this remained significant (adjusted Odds Ratio (OR) 1.24, 95% CI 1.16- 5.29) after adjusting for estimated Glomerular Filtration Rate (eGFR) < 60ml/min/1.73m2, albuminuria and other potential confounders. Adjusting for eGFR as a continuous variable also confirmed this significant association (OR1.15, 95% CI 1.10-7.01). In the subgroup of patients aged ≥ 75 years, only older age was significantly associated with NCA. The incidence of all-cause mortality and composite cardiovascular/cerebrovascular events was similar in the anaemic and nonanaemic groups. CONCLUSION NCA is common in T2DM and has a significant association with older age independent of CKD. The anaemia is mild in most patients and appears to have a benign course.
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Affiliation(s)
- Yen H Wee
- Department of Aged Care and Rehabilitation, General Medicine, Alfred Health, Melbourne, Australia.,Department of General Medicine, Eastern Health, Melbourne, Australia
| | - Mahesan Anpalahan
- Department of General Medicine, Eastern Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
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Loftus TJ, Brakenridge SC, Murphy TW, Nguyen LL, Moore FA, Efron PA, Mohr AM. Anemia and blood transfusion in elderly trauma patients. J Surg Res 2019; 229:288-293. [PMID: 29937004 DOI: 10.1016/j.jss.2018.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/06/2018] [Accepted: 04/12/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The natural history of postinjury among elderly trauma patients has not been well described. We hypothesized that elderly trauma patients would have lower admission hemoglobin (Hb) levels, higher transfusion rates, and worse outcomes than young trauma patients. METHODS We performed a propensity-matched retrospective cohort analysis comparing elderly (age ≥65 y) to young (age 18-64) trauma patients matched by sex, mechanism of injury, Injury Severity Score, base deficit, comorbidities, operative blood loss, and phlebotomy blood loss (n = 41/group). Outcomes included Hb trends, packed red blood cell (PRBC) transfusion, length of stay, and mortality. RESULTS Elderly patients had lower admission Hb (11.3 versus 10.2 g/dL, P = 0.012), received more PRBC transfusions within 24 h (3.6 versus 1.8 units, P = 0.046), and during admission (6.9 versus 4.3 units, P = 0.008). Despite receiving more PRBC transfusions and having similar operative and phlebotomy blood loss, elderly subjects had lower discharge Hb (9.0 versus 9.7 g/dL, P = 0.013). Elderly subjects had fewer ICU-free days (2.0 versus 6.0 d, P < 0.001) and higher in-hospital mortality (15% versus 0%, P = 0.026). CONCLUSIONS Elderly trauma patients had lower admission Hb, received more transfusions, and had persistently lower Hb on discharge when controlling for injury severity, comorbid conditions, and blood loss. Aging may have a negative impact on postinjury anemia.
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Affiliation(s)
- Tyler J Loftus
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida
| | - Scott C Brakenridge
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida
| | - Travis W Murphy
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Linda L Nguyen
- University of Florida College of Medicine, Gainesville, Florida
| | - Frederick A Moore
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida
| | - Philip A Efron
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida
| | - Alicia M Mohr
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida.
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Michalak SS, Rupa-Matysek J, Gil L. Comorbidities, repeated hospitalizations, and age ≥ 80 years as indicators of anemia development in the older population. Ann Hematol 2018; 97:1337-1347. [PMID: 29633008 PMCID: PMC6018572 DOI: 10.1007/s00277-018-3321-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/30/2018] [Indexed: 12/12/2022]
Abstract
Anemia represents a common condition among the elderly; however, its prevalence and causes are not well known. This retrospective analysis was performed on 981 patients aged ≥ 60 in Poland over 2013-2014. The prevalence of anemia was 17.2% and increased with age. The predominant causes of anemia were the following: anemia of chronic disease (33.1%), unexplained anemia (28.4%), deficiency anemia (22.5%, including iron deficiency 13%), and chemo-/radiotherapy-induced anemia (8.9%). In the multivariate logistic regression model, factors increasing the risk of anemia were the following: age ≥ 80 years (OR 2.29; 95%CI 1.19-4.42; P = 0.013), the number of comorbidities (two diseases OR 2.85; 95%CI 1.12-7.30; P = 0.029, three diseases OR 6.28; 95%CI 2.22-17.76; P = 0.001, four diseases OR 4.64; 95%CI 1.27-17.01; P = 0.021), and hospitalizations (OR 1.34; 95%CI 1.13-1.58; P = 0.001). After a 2-year follow-up, the cumulative survival among patients without anemia in relation to the group with anemia was 90.76 vs. 78.08% (P < 0.001). In the multivariate model, anemia (HR 3.33, 95%CI 1.43-7.74, P = 0.005), heart failure (HR 2.94, 95%CI 1.33-6.50, P = 0.008), and cancer (HR 3.31, 95%CI 1.47-7.49, P < 0.004) were all significantly correlated with mortality. In patients ≥ 60 years, the incidence of anemia increases with age, number of comorbidities, and frequency of hospitalizations and has an adverse impact on survival.
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Affiliation(s)
- Sylwia Sulimiera Michalak
- Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznań, Poland
| | - Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznań, Poland.
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznań, Poland
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Kim PK, Hong YJ, Sakuma H, Chawla A, Park JK, Park CH, Hong D, Han K, Lee JY, Hur J, Lee HJ, Kim YJ, Suh YJ, Choi BW. Myocardial Extracellular Volume Fraction and Change in Hematocrit Level: MR Evaluation by Using T1 Mapping in an Experimental Model of Anemia. Radiology 2018; 288:93-98. [DOI: 10.1148/radiol.2018171342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Stucchi M, Cantoni S, Piccinelli E, Savonitto S, Morici N. Anemia and acute coronary syndrome: current perspectives. Vasc Health Risk Manag 2018; 14:109-118. [PMID: 29881284 PMCID: PMC5985790 DOI: 10.2147/vhrm.s140951] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Reference hemoglobin (Hb) values for the definition of anemia are still largely based on the 1968 WHO Scientific Group report, which established a cutoff value of <13 g/dL for adult men and <12 g/dL for adult nonpregnant women. Subsequent studies identified different normal values according to race and age. Estimated prevalence of anemia on admission in the setting of an acute coronary syndrome (ACS) is between 10% and 43% of the patients depending upon the specific population under investigation. Furthermore, up to 57% of ACS patients may develop hospital-acquired anemia (HAA). Both anemia on admission and HAA are associated with worse short- and long-term mortality, even if different mechanisms contribute to their prognostic impact. Baseline anemia can usually be traced back to preexisting disease that should be specifically investigated and corrected whenever possible. HAA is associated with clinical characteristics, medical therapy and interventional procedures, all eliciting cardiovascular adaptive response that can potentially worsen myocardial ischemia. The intrinsic fragility of anemic patients may limit aggressive medical and interventional therapy due to an increased risk of bleeding, and could independently contribute to worse outcome. However, primary angioplasty for ST elevation ACS should not be delayed because of preexisting (and often not diagnosed) anemia; delaying revascularization to allow fast-track anemia diagnosis is usually feasible and justified in non-ST-elevation ACS. Besides identification and treatment of the underlying causes of anemia, the only readily available means to reverse anemia is red blood cell transfusion. The adequate transfusion threshold is still being debated, although solid evidence suggests reserving red blood cell transfusions for patients with Hb level <8 g/dL and considering it in selected cases with Hb levels of between 8 and 10 g/dL. No evidence supports the use of iron supplements and erythropoiesis-stimulating agents in the setting of ACS.
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Affiliation(s)
| | - Silvia Cantoni
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda Ca’ Granda, Milano, Italy
| | | | | | - Nuccia Morici
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda Ca’ Granda, Milano, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
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Sturtzel B, Elmadfa I, Hermann B, Schippinger W, Ohrenberger G. Effects of an enhanced iron dense foods offering in the daily meals served in geriatric institutions on measures of iron deficiency anemia. BMC Geriatr 2018; 18:123. [PMID: 29801478 PMCID: PMC5970462 DOI: 10.1186/s12877-018-0800-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 04/30/2018] [Indexed: 12/18/2022] Open
Abstract
Background Iron deficiency is one of the most common causes of anemia in geriatric patients. Although the oral iron intake is often inadequate, the potential of iron dense foods in the daily meals of geriatric institutions is rarely considered. To test during a 1- year span whether an improved frequency of iron dense foods in the daily meals has an impact on the oral iron intake, the hemoglobin concentration and anemia prevalence of institutionalized geriatric patients. A parallel, open, pre-and post-oral nutrition intervention study. Two geriatric hospitals participated as intervention centers and one as comparison center. Methods In the two intervention centers, a menu plan adapted with iron dense foods was applied. In the comparison center the regular meals provisions was continued. At months 1, 6 and 12 of the intervention time the routine blood-parameter hemoglobin was taken from the geriatric hospital’s medical report. Component analysis assessed the nutrient density of the offered meals. 2-day-weighing records realized at month 1 and 6 of intervention-time assessed the iron intake. Ninety-nine geriatric patients in the intervention centers and 37 in the comparison center. All of them had multiple chronic diseases and an average age of 84 years. With the non-parametric Friedmann-Test for repeated measurements, we establish differences within the groups. With the Mann-Whitney-U-Test, we establish differences between the groups. For dichotomous variables, the chi-square-test was used. A p-value of< 0.05 was considered statistically significant for all analyses. Results In the intervention centers the iron intake (p < 0.001) and the hemoglobin concentration (p = 0.002) improved significantly (p < 0.001). As in the comparison center the frequency of meat and sausage offerings was twice as much as recommended also the hemoglobin concentration improved (p = 0.001). Conclusion Geriatric patients with anemia or low hemoglobin level benefit optimally from a diet rich in iron dense foods. Enhanced access to such can indeed correct iron deficiency anemia. Trial registration The ethics committee of the Municipality of Vienna (EK-13-043-0513) approved the study.
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Affiliation(s)
- Baerbel Sturtzel
- Department of Nutritional Sciences, University of Vienna, Althanstraße 14, 1090, Vienna, Austria.
| | - Ibrahim Elmadfa
- Department of Nutritional Sciences, University of Vienna, Althanstraße 14, 1090, Vienna, Austria
| | - Brigitte Hermann
- Albert Schweitzer Hospital, Long term care hospital, Albert-Schweitzer-Gasse 36, 8020, Graz, Austria
| | - Walter Schippinger
- Albert Schweitzer Hospital, Long term care hospital, Albert-Schweitzer-Gasse 36, 8020, Graz, Austria
| | - Gerald Ohrenberger
- Haus der Barmherzigkeit, Long term care hospital, Seeböckgasse 30a, 1060, Vienna, Austria
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Casteleyn I, Joosten E. Evaluation of Parenteral Iron Therapy in Ambulatory Older Adults with Iron Deficiency Anaemia. Acta Haematol 2017; 138:221-222. [PMID: 29237150 DOI: 10.1159/000484654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/25/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Ilse Casteleyn
- Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
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Joosten E. Iron deficiency anemia in older adults: A review. Geriatr Gerontol Int 2017; 18:373-379. [PMID: 29094497 DOI: 10.1111/ggi.13194] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 12/24/2022]
Abstract
Anemia in older adults is a risk factor for numerous negative outcomes. There is no standard definition, but in most studies, anemia is defined as a hemoglobin value <12 g/dL for women and <13 g/dL for men. Absolute iron deficiency anemia is defined as the combination of anemia and the absence of total body iron. Serum ferritin is the most frequently used diagnostic parameter, but its concentration increases with age and in the presence of inflammatory diseases. Other laboratory tests, such as transferrin saturation, soluble transferrin receptor and the soluble transferrin receptor/ferritin index might provide useful information, but there is a wide variety in the cut-off values and interpretation of the results. Recent research regarding hepcidin as a central regulator of iron homeostasis is promising, but it has not been used yet for the routine diagnosis of iron deficiency anemia. In older iron deficiency anemia patients, an esophagogastroduodenoscopy and colonoscopy should be initiated in order to identify the underlying bleeding cause. CT colonography can replace a colonoscopy, and in specific cases, a video capsule is recommended. It remains crucial to keep in mind which potential benefits might be expected from these investigations in this vulnerable population, taking into account the comorbidity and life expectancy, and one should discuss in advance the possible therapeutic options and complications with the patient, a family member or a proxy. Oral iron administration is the standard treatment, but parenteral iron is a convenient and safe way to provide the total iron dose in one or a few sessions. Geriatr Gerontol Int 2018; 18: 373-379.
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Affiliation(s)
- Etienne Joosten
- Department of Internal Medicine, Division of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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Clere-Jehl R, Schaeffer M, Vogel T, Kiesmann M, Pasquali JL, Andres E, Bourgarit A, Goichot B. Upper and lower gastrointestinal endoscopies in patients over 85 years of age: Risk-benefit evaluation of a longitudinal cohort. Medicine (Baltimore) 2017; 96:e8439. [PMID: 29095285 PMCID: PMC5682804 DOI: 10.1097/md.0000000000008439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
After age 85, upper and lower gastrointestinal (GI) endoscopy may be indicated in 5% to 10% of inpatients, but the risk-benefit ratio is unknown. We studied patients older than 85 years undergoing upper and lower GI endoscopy.We analyzed a retrospective cohort of inpatients older than 85 years between 2004 and 2012, all explored by upper and complete lower GI endoscopy. Initial indications, including iron deficiency anemia (IDA), other anemias, GI bleeding, weight loss, and GI symptoms, were noted, as were endoscopy or anesthesia complications, immediate endoscopic diagnosis, and the ability to modify the patients' therapeutics. Deaths and final diagnosis for initial endoscopic indication were analyzed after at least 12 months.We included 55 patients, 78% women, with a median age, reticulocyte count, hemoglobin, and ferritin levels of 87 (85-99), 56 (24-214) g/L, 8.6 (4.8-12.9) g/dL, and 56 (3-799) μg/L, respectively. IDA was the most frequent indication for endoscopy (60%; n = 33). Immediate diagnoses were found in 64% of the patients (n = 35), including 25% with GI cancers (n = 14) and 22% with gastroduodenal ulcers or erosions (n = 12). Cancer diagnosis was associated with lower reticulocyte count (45 vs. 60 G/L; P = .02). Among the 35 diagnoses, 94% (n = 33) led to modifications of the patients' therapeutics, with 29% of the patients deciding on palliative care (n = 10). No endoscopic complications lead to death. Follow-up of >12 months was available in 82% (n = 45) of the patients; among these patients, 40% (n = 27) died after an average 24 ± 18 months. Cancer diagnosis was significantly associated with less ulterior red cell transfusion (0% vs. 28%; P = .02) and fewer further investigations (6.7% vs. 40%; P = .02).Upper and complete lower GI endoscopy in patients older than 85 years appears to be safe, and enables a high rate of immediate diagnosis, with significant modifications of therapeutics. GI cancers represented more than one-third of the endoscopic diagnoses.
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Affiliation(s)
- Raphaël Clere-Jehl
- Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital
| | | | | | | | | | - Emmanuel Andres
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Bourgarit
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Bernard Goichot
- Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital
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Abstract
BACKGROUND Anemia is an issue of concern in the management of older patients with cancer. In this age group, the incidence and prevalence of both cancer and anemia increase with age. METHODS The clinical consequences and the management of anemia, a common comorbid condition in older patients with cancer, are explored. RESULTS Common causes of chronic anemia include iron deficiency and anemia of chronic disease. The prevalence of vitamin B12 deficiency due to reduced absorption of food-bound vitamin B12 also increases with aging. Although in many cases the cause of anemia is not found, a primary deficiency of erythropoietin may be at fault in at least some of these cases since the response of erythropoietin to anemia may decrease in individuals over age 70. CONCLUSIONS Anemia should not necessarily be ascribed to cancer or aging. The causes of anemia should be pursued and reversed, and hemoglobin levels should be maintained at a minimum of 12 g/dL in cancer patients undergoing chemotherapy who are responsive to erythropoietin. The reversal of anemia may offset or delay the accumulation of catabolic cytokines that may be responsible for functional decline in aging individuals.
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Affiliation(s)
- Lodovico Balducci
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center Research Institute, Tampa, FL 33612, USA.
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Tjahjadi C, Wee Y, Hay K, Tesar P, Clarke A, Walters DL, Bett N. Heyde syndrome revisited: anaemia and aortic stenosis. Intern Med J 2017; 47:814-818. [DOI: 10.1111/imj.13419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/22/2017] [Accepted: 02/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Catherina Tjahjadi
- Department of Cardiology; Prince Charles Hospital; Brisbane Queensland Australia
| | - Yong Wee
- Department of Cardiology; Prince Charles Hospital; Brisbane Queensland Australia
| | - Karen Hay
- Department of Statistics; QIMR Berghofer Medical Research Institute; Brisbane Queensland Australia
| | - Peter Tesar
- Department of Cardiac Surgery; Prince Charles Hospital; Brisbane Queensland Australia
| | - Andrew Clarke
- Department of Cardiothoracic Surgery; Prince Charles Hospital; Brisbane Queensland Australia
| | - Darren L. Walters
- Department of Cardiology; Prince Charles Hospital; Brisbane Queensland Australia
| | - Nicholas Bett
- Department of Cardiology; Prince Charles Hospital; Brisbane Queensland Australia
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29
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Lee DT, Plesa ML. Anemia. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Steensma DP. New challenges in evaluating anemia in older persons in the era of molecular testing. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:67-73. [PMID: 27913464 PMCID: PMC6142435 DOI: 10.1182/asheducation-2016.1.67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Anemia is common in older persons, and often remains unexplained despite a thorough clinical history, physical examination, and focused laboratory testing, including marrow aspiration, biopsy, and karyotyping. The advent of molecular genetic testing panels in hematology clinical practice has complicated the evaluation of older patients with unexplained anemia. While the presence of a somatic mutation provides evidence of clonal hematopoiesis and may support a diagnosis of a hematologic neoplasm such as one of the myelodysplastic syndromes (MDS), with rare exceptions, individual mutations are not strongly associated with one specific diagnosis, nor are they by themselves diagnostic of neoplasia. A clonal mutation in a patient with cytopenias and a nondiagnostic bone marrow may indicate a syndrome with a similar natural history to MDS, but at present there are no clear criteria to distinguish cytopenias coincidentally seen in association with an unrelated clonal mutation from cytopenias that are directly caused by that mutation. Ongoing and planned analyses will help define when mutation patterns alone can identify a disorder equivalent to a morphologically defined myeloid neoplasm such as MDS, further clarifying the etiology and natural history of unexplained anemia in the elderly.
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Affiliation(s)
- David P Steensma
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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31
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Clere-Jehl R, Sauleau E, Ciuca S, Schaeffer M, Lopes A, Goichot B, Vogel T, Kaltenbach G, Bouvard E, Pasquali JL, Sereni D, Andres E, Bourgarit A. Outcome of endoscopy-negative iron deficiency anemia in patients above 65: A longitudinal multicenter cohort. Medicine (Baltimore) 2016; 95:e5339. [PMID: 27893668 PMCID: PMC5134861 DOI: 10.1097/md.0000000000005339] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
After the age of 65 years, iron deficiency anemia (IDA) requires the elimination of digestive neoplasia and is explored with upper and lower gastrointestinal (GI) endoscopy. However, such explorations are negative in 14% to 37% of patients. To further evaluate this issue, we evaluated the outcomes of patients aged over 65 years with endoscopy-negative IDA.We retrospectively analyzed the outcomes of in-patients over the age of 65 years with IDA (hemoglobin <12 g/dL and ferritin <70 μg/L) who had negative complete upper and lower GI endoscopies in 7 tertiary medical hospitals. Death, the persistence of anemia, further investigations, and the final diagnosis for IDA were analyzed after at least 12 months by calling the patients' general practitioners and using hospital records.Between 2004 and 2011, 69 patients (74% women) with a median age of 78 (interquartile range (IQR) 75-82) years and hemoglobin and ferritin levels of 8.4 (IQR 6.8-9.9) g/dL and 14 (IQR 8-27) μg/L, respectively, had endoscopy-negative IDA, and 73% of these patients received daily antithrombotics. After a follow-up of 41 ± 22 months, 23 (33%) of the patients were dead; 5 deaths were linked with the IDA, and 45 (65%) patients had persistent anemia, which was significantly associated with death (P = 0.007). Further investigations were performed in 45 patients; 64% of the second-look GI endoscopies led to significant changes in treatment compared with 25% for the capsule endoscopies. Conventional diagnoses of IDA were ultimately established for 19 (27%) patients and included 3 cancer patients. Among the 50 other patients, 40 (58%) had antithrombotics.In endoscopy-negative IDA over the age of 65 years, further investigations should be reserved for patients with persistent anemia, and second-look GI endoscopy should be favored. If the results of these investigations are negative, the role of antithrombotics should be considered.
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Affiliation(s)
- Raphaël Clere-Jehl
- Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital
| | - Erik Sauleau
- Medical Information and Statistics Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg
| | - Stefan Ciuca
- Internal Medicine Department, Saint-Louis Hospital
| | - Mickael Schaeffer
- Medical Information and Statistics Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg
| | - Amanda Lopes
- Internal Medicine Department, Lariboisière Hospital, APHP, University Hospital of Paris, Paris
| | - Bernard Goichot
- Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital
| | - Thomas Vogel
- Geriatric Department, Robertsau Hospital, University Hospital of Strasbourg, Strasbourg
| | - Georges Kaltenbach
- Geriatric Department, Robertsau Hospital, University Hospital of Strasbourg, Strasbourg
| | - Eric Bouvard
- Acute Gerontology Department, Tenon Hospital, APHP, University Hospital of Paris, Paris
| | | | | | - Emmanuel Andres
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Bourgarit
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
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32
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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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Câlmâc L, Bătăilă V, Ricci B, Vasiljevic Z, Kedev S, Gustiene O, Trininic D, Knežević B, Miličić D, Dilic M, Manfrini O, Cenko E, Badimon L, Bugiardini R, Scafa-Udriște A, Tăutu O, Dorobanțu M. Factors associated with use of percutaneous coronary intervention among elderly patients presenting with ST segment elevation acute myocardial infarction (STEMI): Results from the ISACS-TC registry. Int J Cardiol 2016; 217 Suppl:S21-6. [DOI: 10.1016/j.ijcard.2016.06.227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/25/2016] [Indexed: 12/14/2022]
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Myelodysplastic Syndromes in the Elderly: Treatment Options and Personalized Management. Drugs Aging 2016; 32:891-905. [PMID: 26476843 DOI: 10.1007/s40266-015-0312-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Myelodysplastic syndromes (MDS) are typical diseases of the elderly, with a median age of 68-75 years at initial diagnosis. Demographic changes producing an increased proportion of elderly in our societies mean the incidence of MDS will rise dramatically. Considering the increasing number of treatment options, ranging from best supportive care to hematopoietic stem cell transplantation (HSCT), decision making is rather complex in this cohort of patients. Moreover, aspects of the aging process also have to be considered in therapy planning. Treatment of elderly MDS patients is dependent on the patient's individual risk and prognosis. Comorbidities play an essential role as predictors of survival and therapy tolerance. Age-adjusted models and the use of geriatric assessment scores are described as a basis for individualized treatment algorithms. Specific treatment recommendations for the different groups of patients are given. Currently available therapeutic agents, including supportive care, erythropoiesis-stimulating agents (ESAs), immune-modulating agents, hypomethylating agents, and HSCT are described in detail and discussed with a special focus on elderly MDS patients. The inclusion of elderly patients in clinical trials is of utmost importance to obtain data on efficacy and safety in this particular group of patients. Endpoints relevant for the elderly should be integrated, including maintenance of quality of life and functional activities as well as evaluation of use of healthcare resources.
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Abstract
Anemia is a common diagnosis in the geriatric population, especially in institutionalized and hospitalized elderly. Most common etiologies for anemia in elderly people admitted to a geriatric ward are iron-deficiency anemia and anemia associated with chronic disease. Determination of serum ferritin is the most used assay in the differential diagnosis, despite low sensitivity and moderate specificity. New insights into iron homeostasis lead to new diagnostic assays such as serum hepcidin, serum transferrin receptor and reticulocyte hemoglobin equivalent.Importance of proper diagnosis and treatment for this population is large since there is a correlation between anemia and morbidity - mortality. Anemia is usually defined as hemoglobin less than 12 g/dl for women and less than 13 g/dl for men. There is no consensus for which hemoglobinvalue an investigation into underlying pathology is obligatory. This needs to be evaluated depending on functional condition of the patient.
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Affiliation(s)
- Tuur Helsen
- afdeling geriatrie, Universitaire Ziekenhuizen Leuven, Grimdestraat 13, 3000, Leuven, België.
| | - Etienne Joosten
- afdeling geriatrie, Universitaire Ziekenhuizen Leuven, Grimdestraat 13, 3000, Leuven, België
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36
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Hirani V, Naganathan V, Blyth F, Le Couteur DG, Seibel MJ, Waite LM, Handelsman DJ, Hsu B, Cumming RG. Low Hemoglobin Concentrations Are Associated With Sarcopenia, Physical Performance, and Disability in Older Australian Men in Cross-sectional and Longitudinal Analysis: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2016; 71:1667-1675. [PMID: 26994391 DOI: 10.1093/gerona/glw055] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/01/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The objective of this study is to examine associations between Hb levels and sarcopenia, low muscle strength, functional measures, and activities of daily living (ADL) and instrumental ADL (IADL) disabilities in older Australian men. METHODS Men aged 70 years and older (2005-2007) from the Concord Health and Ageing in Men Project were assessed at baseline (n = 1,705), 2 years (n = 1,367), and 5 years (n = 958). The main outcome measurements were walking speed, muscle strength, ADL and IADL disabilities, and sarcopenia using the Foundation for the National Institutes of Health criteria (low appendicular lean mass adjusted for body mass index < 0.789 and poor grip strength < 26kg). Analysis was performed using Hb levels as a continuous measure, unadjusted and adjusted by age, income, body mass index, measures of health, estimated glomerular function, inflammatory markers, and medication use. Receiver operating characteristic curve analysis was performed to determine a threshold of Hb for each outcome. RESULTS In cross-sectional and longitudinal analysis, for every 1g/dL increase in Hb, there was a significant reduction in risk of sarcopenia, slow walking speed, poor grip strength, inability to perform chair stands, and ADL and IADL disabilities in unadjusted, age-adjusted, and multivariate-adjusted analysis. The highest value of the Youden Index for Hb was 14.2g/dL for sarcopenia and grip strength, 14.5g/dL for walking speed, and 14.4g/dL for all other outcomes. CONCLUSION Declines in Hb levels over time are associated with poor functional outcomes. The risks and benefits of interventions to increase Hb among older men warrant further investigation to differentiate whether this is an active contributor to age-related debility or a passive biomarker of it.
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Affiliation(s)
- Vasant Hirani
- School of Life and Environmental Sciences Charles Perkins Centre, .,Centre for Education and Research on Ageing, Concord Hospital.,The ARC Centre of Excellence in Population Ageing Research
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital
| | - Fiona Blyth
- Centre for Education and Research on Ageing, Concord Hospital
| | | | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, Department of Endocrinology and Metabolism, Concord Hospital
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital
| | - David J Handelsman
- Department of Andrology, ANZAC Research Institute, Concord Hospital, and
| | - Ben Hsu
- Department of Andrology, ANZAC Research Institute, Concord Hospital, and
| | - Robert G Cumming
- Centre for Education and Research on Ageing, Concord Hospital.,The ARC Centre of Excellence in Population Ageing Research.,School of Public Health, University of Sydney, New South Wales, Australia
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37
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Abstract
Iron deficiency anemia (IDA) is a global public health crisis, so also in India. As per the World Health Organization's report, half of the total anemia is IDA. Ayurveda offers several formulations for the management of IDA. Given in this context, a systematic review was carried out to understand the role of Ayurvedic formulations for the management of IDA. For this purpose, articles were obtained from PubMed and through hand search process. Of the 37 articles identified, 10 articles were finally selected for the review. Of the 10 studies identified, 3 studies were (n = 10) exclusively focused on pregnant women, 2 studies (n = 10) were exclusively focused on pediatric age group, 1 study (n = 10) was exclusively focused on geriatric anemia and 4 studies (n = 10) were focused on general population. The response of most of the Ayurvedic formulations was better than Allopathic formulations and there was no untoward effect as observed with iron salts. Statistically significant results were obtained in favor of most of the Ayurvedic formulations in subjective and hematological parameters. Among six different formulations, Sarva-Jvara-Hara Lauha is suggested as the drug of choice for IDA as the Hb regeneration with this drug is highest- 0.16 g/dl/day, as reported by one of the studies. In addition, Punarnavadi Mandura is currently used as an anemia correcting agent at the community level promoted by the National Rural Health Mission and is included in the Accredited Social Health Activist's drugs kit. As most of these Ayurvedic formulations are found effective against IDA, their usage should be fostered at all level in addition to modern allopathic medicines.
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Affiliation(s)
- Janmejaya Samal
- Medical Consultant-Urban TB, Catholic Health Association of India (CHAI), Chhattisgarh, India
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38
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van Staden AM, Weich DJV. Retrospective analysis of the prevalence and causes of anaemia in hospitalised elderly patients. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2015.1071538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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39
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Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol 2015; 52:261-9. [PMID: 26404438 DOI: 10.1053/j.seminhematol.2015.07.006] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Anemia is a global public health problem affecting both developing and developed countries at all ages. According to the World Health Organization (WHO), anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men. However, normal Hb distribution varies not only with sex but also with ethnicity and physiological status. New lower limits of normal Hb values have been proposed, according to ethnicity, gender, and age. Anemia is often multifactorial and is not an independent phenomenon. For the classification and diagnosis the hematologic parameters, the underlying pathological mechanism and patient history should be taken into account. The aging of population, especially in Western countries, causes an increase of anemia in elderly people. In this population, anemia, recently defined by levels of Hb <12 g/dL in both sexes, is mostly of mild degree (10-12 g/dL). Understanding the pathophysiology of anemia in this population is important because it contributes to morbidity and mortality. In one third of the patients, anemia is due to nutritional deficiency, including iron, folate, or vitamin B12 deficiency; moreover, anemia of chronic disease accounts for about another third of the cases. However, in one third of patients anemia cannot be explained by an underlying disease or by a specific pathological process, and for this reason it is defined "unexplained anemia". Unexplained anemia might be due to the progressive resistance of bone marrow erythroid progenitors to erythropoietin, and a chronic subclinical pro-inflammatory state.
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Affiliation(s)
- M Domenica Cappellini
- Department of Medicine, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Science and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Irene Motta
- Department of Medicine, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Science and Community Health, Università degli Studi di Milano, Milan, Italy
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40
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Sudarsky D, Sudarsky M, Matezky S, Goldenberg I, Farcas A, Nikolsky E. Impact of Early Invasive Approach on Outcomes of Patients With Acute Coronary Syndrome and Baseline Anemia: Analysis From the ACSIS Registry. J Interv Cardiol 2015; 28:315-25. [PMID: 26139008 DOI: 10.1111/joic.12216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Anemia in patients with acute coronary syndromes (ACS) is strongly related to the increased risk of bleeding and mortality. Whether benefit of early invasive strategy exceeds the risk of bleeding in these patients is unknown. AIM To assess impact of early coronary angiography on outcomes of patients with ACS and baseline anemia. METHODS AND RESULTS Biennial Israeli ACS registry (ACSIS) prospectively collects data from all 26 public hospitals. The endpoints included rates of in-hospital major bleeding, as well as 30-day and 1-year mortality. Anemia at baseline was present in 1,464 of 5,600 patients with ACS (26.1%). Coronary angiography within index hospitalization was performed less frequently in patients with anemia (76.6% vs. 90.8%, P < 0.001). Non-performance of coronary angiography was associated with older age and higher prevalence of comorbidities. Among patients with anemia who underwent coronary angiography, the majority (95.5%) had obstructive coronary disease, of whom 77.8% were triaged to revascularization. Performance of coronary angiography was associated with significantly lower (P < 0.0001) rates of mortality at 30 days (5.7% vs. 15.6%) and at 1 year (11.9% vs. 34.1%). Major bleeding occurred with similar incidence in groups with and without coronary angiography (3.1% vs. 3.8%, respectively; P = 0.54). By multivariable analysis, performance of coronary angiography was an independent predictor of lower 1-year mortality (hazard ratio [95%CI] = 0.30 [0.21, 0.44]. CONCLUSION In the setting of ACS, despite the presence of baseline anemia, early coronary angiography with subsequent revascularization, when indicated, was associated with improved clinical outcomes including 1-year mortality without significant increase in rates of major bleeding.
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Affiliation(s)
- Doron Sudarsky
- Heart Institute, Ha'Emek Medical Center, Afula.,Technion-Israel Institute of Technology, Haifa
| | - Merav Sudarsky
- Technion-Israel Institute of Technology, Haifa.,Clalit Health Services, Haifa and Western Galilee District
| | - Shlomi Matezky
- Leviev Heart Center, the Sheba Medical Center at Tel Hashomer, Tel Aviv.,Tel Aviv University, Tel Aviv
| | - Ilan Goldenberg
- Tel Aviv University, Tel Aviv.,Neufeld Cardiac Research Institute, the Sheba Medical Center at Tel Hashomer, Tel Aviv
| | - Ateret Farcas
- Neufeld Cardiac Research Institute, the Sheba Medical Center at Tel Hashomer, Tel Aviv
| | - Eugenia Nikolsky
- Technion-Israel Institute of Technology, Haifa.,Cardiology Department, Rambam Health Care Campus, Haifa, Israel
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Cross-Sectional and Longitudinal Associations Between Anemia and Frailty in Older Australian Men: The Concord Health and Aging in Men Project. J Am Med Dir Assoc 2015; 16:614-20. [DOI: 10.1016/j.jamda.2015.02.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/02/2015] [Accepted: 02/16/2015] [Indexed: 12/27/2022]
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42
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Hellhammer K, Balzer J, Zeus T, Rammos C, Niebel S, Kubatz L, Wagstaff R, Kelm M, Rassaf T. Percutaneous mitral valve repair using the MitraClip® system in patients with anemia. Int J Cardiol 2015; 184:399-404. [DOI: 10.1016/j.ijcard.2015.02.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/16/2015] [Accepted: 02/22/2015] [Indexed: 10/24/2022]
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43
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Assesment of the patients presenting with severe anemia to the emergency internal medicine clinic. North Clin Istanb 2014; 1:84-88. [PMID: 28058308 PMCID: PMC5175068 DOI: 10.14744/nci.2014.10820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/11/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Etiological evaluation of the patients who were hospitalized with the diagnosis of severe anemia (Hb<7 gr/dl) in the emergency internal medicine clinic between January and July, 2013. METHODS: In this study, 112 patients who were hospitalized in Dr. Lutfi Kirdar Kartal Education and Research Hospital emergency internal medicine clinic with severe anemia between January and July 2013 were retrospectively analyzed. Patients’ initial complaints, underlying causes of their anemia and prognosis of the patients were evaluated. RESULTS: The etiology of anemia was iron deficiency in 60 (53.6%), chronic kidney failure in 16 (14.2%), hematologic malignancies in 12 (10.7%), liver cirrhosis in 12 (10.7%) and other non-malignant hematologic disorders in 4 (3.6%) patients. CONCLUSION: The most common cause of anemia in patients who apply to emergency internal medicine clinic with severe anemia is iron deficiency. The most common complaints on admission are subjective ones such as weakness, fatigue and lassitude. Chronic disease anemia does not cause severe anemia as much as iron deficiency.
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44
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Chung SD, Sheu JJ, Kao LT, Lin HC, Kang JH. Dementia is associated with iron-deficiency anemia in females: A population-based study. J Neurol Sci 2014; 346:90-3. [DOI: 10.1016/j.jns.2014.07.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 11/25/2022]
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45
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Morici N, Cantoni S, Antonicelli R, Murena E, Cavallini C, Petronio AS, Toso A, Bonechi F, De Servi S, Savonitto S. Anemia in octogenarians with non-ST elevation acute coronary syndrome: Aging or disease? Int J Cardiol 2014; 176:1147-9. [DOI: 10.1016/j.ijcard.2014.07.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
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46
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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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47
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Bach V, Schruckmayer G, Sam I, Kemmler G, Stauder R. Prevalence and possible causes of anemia in the elderly: a cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging 2014; 9:1187-96. [PMID: 25092968 PMCID: PMC4113572 DOI: 10.2147/cia.s61125] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Anemia in later life is associated with increased morbidity and mortality. The purpose of this study was to evaluate the prevalence and possible causes of anemia in the elderly in a well defined hospital cohort. Methods Participants in this cross-sectional, retrospective analysis included all inpatients and outpatients aged ≥64 years with complete blood counts treated at Innsbruck Medical University Hospital between October 1, 2004 and September 29, 2005 (n=19,758, median age 73 years). Results According to World Health Organization criteria, 21.1% of these patients were anemic, ie, 30.7% and 37.0% at 80+ years and 90+ years, respectively. The prevalence of anemia was significantly correlated with advanced age (r=0.21; P<0.001) and male sex (P<0.001). In anemic patients, renal insufficiency with a glomerular filtration rate <30 mL/min/1.73 m2 (11.3% versus 2.1%), hyperinflammation (62.1% versus 31.4%), absolute (14.4% versus 6.9%) or functional (28.2% versus 11.8%) iron deficiency, and folate deficiency (6.7% versus 3.0%) were observed significantly more often than in nonanemic subjects (P<0.001). The pathogenesis of anemia was multifactorial, with decreased renal function (glomerular filtration rate <60 mL/min/1.73 m2), signs of inflammation, and functional iron deficiency detected in 11.4% of anemic patients. Hemoglobin was significantly correlated with elevated C-reactive protein (r= −0.296; P<0.001) and low transferrin saturation (r=0.313; P<0.001). Mean corpuscular volume correlated only weakly with the various anemia subtypes. Cytopenias and morphologic alterations suggestive of underlying myelodysplastic syndromes were found in a substantial proportion of anemic patients, including thrombocytopenia (5.4%), leukopenia (8.26%), and macrocytic alterations (18.4%). Conclusion Anemia was frequently diagnosed in this series of elderly patients. Partly treatable nutritional deficiencies, such as iron or folate deficiency, were identified as possible causes. A complex and heterogeneous interplay of chronic inflammation, functional iron deficiency, and renal impairment was identified in a large proportion of patients. A hitherto undiagnosed myelodysplastic syndrome can be assumed in a relevant proportion of patients. Morphologic classification based on mean corpuscular volume is inadequate from the standpoint of pathogenesis. New parameters are needed to differentiate the multifactorial pathogenesis of anemia in the elderly.
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Affiliation(s)
- Veronika Bach
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Guenter Schruckmayer
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Ines Sam
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Georg Kemmler
- Department of Biological Psychiatry, Innsbruck Medical University, Innsbruck, Austria
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
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Pandya MG, Dave AR. A clinical study of Punarnava Mandura in the management of Pandu Roga in old age (geriatric anemia). Ayu 2014; 35:252-60. [PMID: 26664234 PMCID: PMC4649575 DOI: 10.4103/0974-8520.153735] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The incidence of anemia rises with age. The consequences of anemia are many and serious, affecting not only individual's health, but also the development of societies and countries. Pandu Roga can be effectively compared with anemia on the ground of its similar signs and symptoms. AIM To evaluate the Panduhara and Rasayana effect of Punarnava Mandura in the management of Pandu Roga in old age (geriatric anemia). MATERIALS AND METHODS The study was conducted in 50 clinically diagnosed patients of geriatric anemia. Patients were treated with Punarnava Mandura 2 tablets (250 mg each) twice in a day after lunch and dinner with Takra (butter milk) for 90 days. Among 50 registered patients, 40 patients had completed the treatment and 10 patients discontinued the treatment. Results were analyzed using Wilcoxon signed-rank test for subjective parameters and for assessment of objective parameters paired t-test was adopted. RESULTS At the end of study, drug has shown beneficial effect in patients of anemia by providing highly significant result in chief complaints, associated symptoms, Kshaya of Dhatu and Agni Bala, Deha Bala and Sattwa Bala. It has also improved quality-of-life (QOL) of the patients. Moderate and mild improvement was observed in 30 and 70% of the patients respectively. CONCLUSION Punarnava Mandura may work as Rasayana in geriatric anemia by providing highly significant results on clinical features of Pandu Roga, Dehabala, Agni Bala and Sattwa Bala and by improving QOL. of patients of geriatric anemia.
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Affiliation(s)
- Megha G. Pandya
- Department of Kayachikitsa, Shree Gulabkunverba Ayurveda Mahavidyalaya, Jamnagar, India
| | - Alankruta R. Dave
- Department of Kayachikitsa, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
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Savonitto S, Morici N, De Servi S. Update: acute coronary syndromes (VI): treatment of acute coronary syndromes in the elderly and in patients with comorbidities. ACTA ACUST UNITED AC 2014; 67:564-73. [PMID: 24952397 DOI: 10.1016/j.rec.2014.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 01/08/2023]
Abstract
Acute coronary syndromes have a wide spectrum of clinical presentations and risk of adverse outcomes. A distinction should be made between treatable (extent of ischemia, severity of coronary disease and acute hemodynamic deterioration) and untreatable risk (advanced age, prior myocardial damage, chronic kidney dysfunction, other comorbidities). Most of the patients with "untreatable" risk have been excluded from the "guideline-generating" clinical trials. In recent years, despite the paucity of specific randomized trials, major advances have been completed in the management of elderly patients and patients with comorbidities: from therapeutic nihilism to careful titration of antithrombotic agents, a shift toward the radial approach to percutaneous coronary interventions, and also to less-invasive cardiac surgery. Further advances should be expected from the development of drug regimens suitable for use in the elderly and in patients with renal dysfunction, from a systematic multidisciplinary approach to the management of patents with diabetes mellitus and anemia, and from the courage to undertake randomized trials involving these high-risk populations.
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Affiliation(s)
| | - Nuccia Morici
- Cardiologia Prima-Emodinamica, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Stefano De Servi
- Cure Intensive Coronariche, IRCCS Policlinico S. Matteo, Pavia, Italy
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