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Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic.

AbstractBACKGROUND:
To accurately determine the causes of anemia and proportion of unexplained anemia in a racially diverse cohort of older adults after a comprehensive and standardized evaluation.
METHODS:
We evaluated results from a single-institutional university anemia clinic. Patients with anemia, defined as a hemoglobin less than 13.0 g/dL for men and less than 12.0 g/dL for women, underwent a prospective standardized history, physical examination, and laboratory measures, with additional studies including bone marrow examination as indicated. Empiric treatment trials were given for identified deficiencies.
RESULTS:
One hundred and seventy-four primarily community-dwelling adults aged 65 years and older were evaluable. African Americans accounted for 69% of patients and whites were 27%. Anemia etiologies included iron deficiency anemia at 25.3%, anemia of chronic inflammation at 9.8%, and hematologic malignancy in 7.5%. Unexplained anemia in the elderly accounted for 43.7% and predominated in both African Americans and whites. The prevalence of iron deficiency anemia and hematologic malignancies did not differ by race. Unexplained anemia in the elderly showed a consistent phenotype composed of a hypoproliferative mild-to-moderate anemia with suppressed serum erythropoietin. Specifically, erythropoietin levels showed no correlation with hemoglobin concentration in unexplained anemia in the elderly (r = -.15, p = .19) as opposed to iron deficiency anemia (r = -.63, p < .0001).
CONCLUSIONS:
In summary, an intensive hematologic evaluation reveals a wide number of anemia etiologies among older adults, including 7.5% with hematologic malignancies; nevertheless, unexplained anemia in the elderly prevails as the most common category in whites and African Americans.
AuthorsAndrew S Artz, Michael J Thirman
JournalThe journals of gerontology. Series A, Biological sciences and medical sciences (J Gerontol A Biol Sci Med Sci) Vol. 66 Issue 8 Pg. 925-32 (Aug 2011) ISSN: 1758-535X [Electronic] United States
PMID21659341 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Hemoglobins
  • Erythropoietin
Topics
  • Black or African American (statistics & numerical data)
  • Aged
  • Aging
  • Anemia (blood, diagnosis, ethnology, etiology)
  • Anemia, Iron-Deficiency (complications, epidemiology)
  • Chronic Disease
  • Cohort Studies
  • Erythropoietin (blood)
  • Female
  • Hematologic Neoplasms (complications)
  • Hemoglobins (analysis)
  • Humans
  • Inflammation (complications)
  • Male
  • Outpatient Clinics, Hospital
  • Prevalence
  • Prospective Studies
  • Referral and Consultation
  • White People (statistics & numerical data)

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