Prevalence and Causes of Anemia in Hospitalized Patients: Impact on Diseases Outcome

Abstract

Anemia is extremely common in hospitalized patients who are old and often with multiple diseases. We evaluated 435 consecutive patients admitted in the internal medicine department of a hub hospital and 191 (43.9%) of them were anemic. Demographic, historic and clinical data, laboratory tests, duration of hospitalization, re-admission at 30 days and death were recorded. Patients were stratified by age (<65, 65–80, >80 years), anemia severity, and etiology of anemia. The causes of anemia were: iron deficiency in 28 patients, vitamin B12 and folic acid deficiencies in 6, chronic inflammatory diseases in 80, chronic kidney disease in 15, and multifactorial in 62. The severity of the clinical picture at admission was significantly worse (p < 0.001), length of hospitalization was longer (p < 0.001) and inversely correlated to the Hb concentration, re-admissions and deaths were more frequent (p 0.017) in anemic compared to non-anemic patients. A specific treatment for anemia was used in 99 patients (36.6%) (transfusions, erythropoietin, iron, vitamin B12 and/or folic acid). Anemia (and/or its treatment) was red in the discharge letter only 54 patients. Even if anemia is common, in internal medicine departments scarce attention is paid to it, as it is generally considered a “minor” problem, particularly in older patients often affected by multiple pathologies. Our data indicate the need of renewed medical attention to anemia, as it may positively affect the outcome of several concurrent medical conditions and the multidimensional loss of function in older hospitalized patients.

<p>Iron in the General Population and Specificities in Older Adults: Metabolism, Causes and Consequences of Decrease or Overload, and Biological Assessment</p>

“…14 Hepcidin is a hormone mainly produced in the liver. 4,14,16 It is a peptide regulating the homeostasis of iron metabolism through ferroportin. 18 The serum hepcidin rate fluctuates according to various conditions such as the variations in the body's IR (including in the liver), inflammation, erythropoiesis, and hypoxia.…”

“…This results in iron sequestration in the enterocytes and the macrophages, a decrease in intestinal absorption, and therefore an inhibition of iron transfer to the blood. 4,14,16 Hepcidin is eliminated in the urine, which means that its serum concentration increases during renal failure. 3 The enterocytes are also sensitive to total iron stocks of the body, for which they play a regulatory role.…”

“…If a decrease in the total IR is detected, the iron stored as ferritin in the enterocytes is released and discharged into the blood compartment, via ferroportin, and the intestinal absorption of iron increases. 4,14,16 Conversely, when the IR in the body are normal or too high, iron remains sequestered in the enterocytes due to the inhibition of the ferroportin activity by hepcidin and the intestinal absorption of iron is greatly reduced. 4,14,16 Schematically, ferroportin is a lock and hepcidin is the key.…”

“…FID results in an increase in SF, while, with iron being sequestered in other tissues, the amount of available iron is no longer sufficient to ensure effective erythropoiesis. 4,25…”

“…The consequences include anemia, asthenia (even without anemia), occurrence of cognitive disorders, worsening of neurocognitive disorder (Alzheimer's disease or other), decrease of immune defense causing infections, osteoporosis, and decrease in physical activity. [3][4][5][6][7][8][9] In addition, ID is a marker of the severity of heart failure, which is a frequent condition in OAs. 10 Although the role of iron in human body is well known, there have been recent advances in the understanding of iron metabolism, including its absorption pathways and precise regulation.…”