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Anemia in Elderly

Introduction

  • There are three types of cells that circulate throughout the body, red blood cells, white blood cells and platelets. Anemia is a medical condition that occurs when a person does not have enough red blood cells.

  • Red blood cells, which contain haemoglobin, a red iron-rich protein, carry oxygen from the lungs to all of the body’s muscle and organs. Oxygen provides the energy the body needs for all of its normal activities. The kidneys produce a hormone called Erythropoietin, which stimulates the production of red blood cells in the bone marrow. Reduced levels of erythropoietin or treatment affecting bone marrow (such as chemotherapy) are leading causes of anemia.

  • White blood cells are responsible for fighting infection.

  • Platelets are responsible for aiding in clotting the blood following an injury.

  • Anemia in the elderly may be an indicator of an underlying chronic disease.

  • Anemia in the elderly can be caused by a variety of factors including genetics, vitamin deficiencies, iron deficiency and disease.

  • The most common cause of anemia in the geriatric patient is attributed to chronic disease, including inflammatory disease, malignancy (cancers) and chronic infection. The most common cause is chronic disease. The second most common cause is decreased nutrition, specifically lack of folate and cobalamin (vitamin B12). In 15% anemias in elderly, there are no underlying cause.

  • Understanding the cause and origin of anemia in the elderly, anemia symptoms, diagnosis and treatment, will provide caregivers and adult the tools necessary to assess and provide the appropriate care and guidance to the elderly patient.

Symptoms/Signs

Risk factors – the following factor can increased risk of anemia:

  • Poor diet – anyone – young or old, whose diet is consistently low in iron and vitamins, especially folate, is at risk of anemia. Your body needs iron, protein and vitamins to produce sufficient numbers of red blood cells.

  • Intestinal disorders – having an intestinal disorder that affects the absorption of nutrients in your small intestine – such as Crohn’s disease and celiac disease. Surgical removal of or surgery to the parts of your small intestine where nutrients are absorbed can lead to nutrient deficiencies and anemia.

  • Chronic conditions examples:cancer, kidney or liver failure, or other chronic condition, may put you at risk of what’s called anemia of chronic disease. These conditions can lead to a shortage of red blood cells. Slow, chronic blood loss from an ulcer or other source within your body can deplete your body’s store of iron, leading to iron deficiency anemia.

  • Family history – There may be a history of an inherited anemia, such as sickle cell anemia.

  • Other factors: Certain infections, blood diseases and autoimmune disorders, exposure to toxic chemicals and the use of some medications can affect red blood cell production and lead to anemia. Other people at risk of anemia are people with diabetes, peoples who are dependent on alcohol and people who adhere to a strict vegetarian diet, who may not get enough iron or vitamin B-12 in their diet.

Symptoms / signs very depending on the cause of anemia and coexisting medical conditions, include:

  • Feels fatigue, lethargy and weak

  • Pale skin, sometimes fingernails break easily

  • Chest pain

  • Headache or dizziness

  • A fast or irregular heartbeat

  • Cold hand and feet

  • Shortness of breath

  • Cognitive problems

  • Feels depressed or agitated Initially, anemia can be so mild it goes unnoticed. But signs and symptoms increase as anemia worsens.

Complications

Left untreated, anemia can cause numerous complications, such as:

  • Severe fatigue – when anemia is severe enough, you may be so tired that you can’t complete everyday tasks. You may be too exhausted to work or play.

  • Heart problems – Anemia can lead to a rapid or irregular heartbeat – an arrhythmia. Your heart must pump more blood to compensate for the lack oxygen in the blood when you’re anemic. This can even lead to heart failure.

  • Nerve damage – Vitamin B-12 is essential not only for healthy red blood cell production, but also for healthy nerve function.

  • Impaired mental function – A shortage of vitamin B-12 can also affect your mental abilities, example memory.

  • Death – Some inherited anemia, such as sickle cell anemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemic and can be fatal.

Treatment

Tests and diagnosis

Doctors diagnose anemia with the help of a medical history, a physical examination and blood tests.

  • Complete blood count (CBC) – this blood test measure levels of the red blood cells contained in the blood (hematocrit) and the haemoglobin in your blood. Red blood cells may also be examined under a microscope for;

  • Size, shape and colour. Doing so can help pinpoint a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler in colour than normal.

Additional diagnostic tests

  • Endoscopy – doctors often check for bleeding ulcers and stomach bleeding with the aid of endoscopy. In this procedure, a thin, tube equipped with a light source and video camera is passed down your throat to your stomach. This allows your doctor to view your esophagus – the tube that runs from your mouth to your stomach – to look for sources of bleeding.

  • Colonoscopy – to rule out lower intestinal sources of bleeding, your doctor may recommend a procedure called colonoscopy. A thin, flexible tube equipped with a video camera is inserted into the rectum and guided to your colon. A colonoscopy allows your doctor to view some or all of your colon and rectum to look for internal bleeding

  • Ultrasound – to look for any growth or any abnormalities in your kidney, liver and other organs.

  • Bone marrow aspiration – to study the cause of anemia by looking into the bone which is the factory for producing red blood cells.

Treatments and drugs

Anemia treatment depends on the cause:

  • Iron deficiency anemia: this form of anemia is treated with iron supplements, which may need to take for several months or longer. If the underlying cause of iron deficiency is loss of blood – the source of the bleeding must be located and stopped.

  • Vitamin deficiency anemias: Pernicious anemia is treated with injections – often lifetime injections of vitamin B-12. Folic acid deficiency anemia is treated with folic acid supplements.

  • Anemia of chronic disease: there’s no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by kidneys, may help stimulate red blood cell production and ease fatigue.

  • Aplastic anemia: treatment for this anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can’t make healthy blood cells.

  • Anemia associated with bone marrow disease: treatment of these various diseases can range from simple medication to chemotherapy to bone marrow transplantation.

  • Haemolytic anemias: managing haemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Short courses of treatment with steroids, immune suppressant medications or gamma globulin can help suppress your immune system’s attack on your red blood cells.

Prevention

Some types of anemia may be prevented. You can avoid iron deficiency anemia and vitamin deficiency anemias by eating a healthy, varied diet, including:

  • Iron – the best sources of iron are beef and other meats. Other foods rich in iron include beans, lentils, iron-fortified cereals, dark green leafy vegetables, dried fruit, peanut butter and nuts.

  • Folate – this nutrient, and its synthetic form, folic acid, can be found in citrus juices and fruits, bananas, dark green leafy vegetables, legumes and fortified breads, cereals and pasta.

  • Vitamin B -12 – this vitamin is plentiful in meat and dairy products

  • Vitamin C – foods containing vitamin C, such as citrus fruits, melons and berries, help increase iron absorption.

Last Review : 26 April 2012
Writer : Dr. Sanidah binti Md. Ali
Reviewed : Dr. Sanidah binti Md. Ali