BackgroundIn the elderly persons, hemoglobin concentrations slightly below the lower limit of normal are common, but scant evidence is available on their relationship with significant health indicators. The objective of the present study was to cross-sectionally investigate the association of mild grade anemia with cognitive, functional, mood, and quality of life (QoL) variables in community-dwelling elderly persons.MethodsAmong the 4,068 eligible individuals aged 65–84 years, all persons with mild anemia (n = 170) and a randomly selected sample of non-anemic controls (n = 547) were included in the study. Anemia was defined according to World Health Organization (WHO) criteria and mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. Cognition and functional status were assessed using measures of selective attention, episodic memory, cognitive flexibility and instrumental and basic activities of daily living. Mood and QoL were evaluated by means of the Geriatric Depression Scale-10, the Short-Form health survey (SF-12), and the Functional Assessment of Cancer Therapy-Anemia.ResultsIn univariate analyses, mild anemic elderly persons had significantly worse results on almost all cognitive, functional, mood, and QoL measures. In multivariable logistic regressions, after adjustment for a large number of demographic and clinical confounders, mild anemia remained significantly associated with measures of selective attention and disease-specific QoL (all fully adjusted p<.046). When the lower limit of normal hemoglobin concentration according to WHO criteria was raised to define anemia (+0.2 g/dL), differences between mild anemic and non anemic elderly persons tended to increase on almost every variable.ConclusionsCross-sectionally, mild grade anemia was independently associated with worse selective attention performance and disease-specific QoL ratings.

BackgroundMild anemia is a frequent laboratory finding in the elderly usually disregarded in everyday practice as an innocent bystander. The aim of the present population-based study was to prospectively investigate the association of mild grade anemia with hospitalization and mortality. Design and MethodsA prospective population-based study of all 65 to 84 year old residents in Biella, Italy was performed between 2003 and 2007. Data from a total of 7,536 elderly with blood tests were available to estimate mortality; full health information available to evaluate healthrelated outcomes was available for 4,501 of these elderly subjects. Mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. ResultsThe risk of hospitalization in the 3 years following recruitment was higher among the mildly anemic elderly subjects than among subjects who were not anemic (adjusted hazard ratio: 1.32; 95% confidence interval: 1.09-1.60). Mortality risk in the following 3.5 years was also higher among the mildly anemic elderly (adjusted hazard ratio: 1.86; 95% confidence interval: 1.34-2.53). Similar results were found when slightly elevating the lower limit of normal hemoglobin concentration to 12.2 g/dL in women and to 13.2 g/dL in men. The risk of mortality was significantly increased in mild anemia of chronic disease but not in that due to β-thalassemia minor. ConclusionsAfter controlling for many potential confounders, mild grade anemia was found to be prospectively associated with clinically relevant outcomes such as increased risk of hospitalization and all-cause mortality. Whether raising hemoglobin concentrations can reduce the risks associated with mild anemia should be tested in controlled clinical trials.Key words: mild anemia, elderly, mortality, hospitalization, hemoglobin. Haematologica 2009; 94:22-28. doi: 10.3324/haematol.13449 ©2009 Ferrata Storti Foundation. This is an open-access paper. Citation: Riva E, Tettamanti M, Mosconi P, Apolone G, Gandini F, Nobili A, Tallone MV, Detoma P, Giacomin A, Clerico M, Tempia P, Guala A, Fasolo G, and Lucca U. Association of mild anemia with hospitalization and mortality in the elderly: the Health and Anemia population-based study. Association of mild anemia with hospitalization and mortality in the elderly: the Health and Anemia population-based study

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I was interested to read the article by Avery et al. on cardiac failure secondary to hypocalcaemia of nutritional osteomalacia' 1 '. This paper provides supporting data on the role of hypocalcaemia in the development of reversible heart failure. In this case report, the patient's electrocardiogram revealed sinus rhythm with a left bundle branch block. However, there is no mention of the ECG QT interval. We previously presented a case report of reversible impairment of myocardial function in hypoparathyroidism causing hypocalcaemia. We observed a very close inverse correlation between the QT time and left ventricular function, and a very close positive correlation between the serum calcium level and left ventricular function' 2 '.It would be very useful to know whether or not there is a similar close inverse correlation between the QT interval and left ventricular function in the case of left bundle branch block. The question is of practical importance as the authors postulated that their patient could have had hypocalcaemia 6 months previously, but that the serum calcium level had not been measured. A QT interval prolongation could also provide indirect data on hypocalcaemia in this case.The second major issue is that the echocardiographic data are missing. Thus, one cannot tell to what extent the cardiomegaly seen on the chest X-ray was due to cardiac dilatation alone, or whether any additional pericardial effusion contributed to some extent to the cardiomegaly.