Reduced erythropoietin secretion in senile anemia

Abstract

To investigate the etiology of the age-related decrease in hemoglobin (Hb) concentration, we measured serum erythropoietin (EPO), serum iron, total iron binding capacity, and serum ferritin levels in 247 elderly subjects aged 60-99 years. EPO levels were determined by radioimmunoassay. An age-related increase in the serum EPO concentration (r = 0.220; P < 0.01) and a significant inverse relationship between EPO and Hb concentrations were found in normal elderly subjects without anemia (r = -0.302; P < 0.001), but not in 111 younger controls. Serum EPO levels were slightly higher in elderly subjects with pre-anemic iron deficiency than in the normal elderly subjects (P < 0.05). These results suggest that the EPO secretion is accelerated in the elderly even though the Hb remains above 12.0 g/dl, probably as a compensatory mechanism for peripheral tissue hypoxia. An inverse relationship between the EPO and Hb concentrations was found in the elderly subjects with iron deficiency anemia, but not in those with unexplained senile anemia. The changes of EPO levels were also assessed in 20 elderly subjects who had developed anemia when reviewed after 12 months. Serum EPO levels increased in relation to the decrease in Hb concentration in those with iron deficiency anemia, but not in those with unexplained senile anemia. Reduced EPO secretion thus seems to play a role in the progression of unexplained senile anemia, and recombinant human EPO may possibly be effective for treating this type of anemia by mobilizing excess iron.

Prevalence of anemia in elderly subjects living at home: role of micronutrient deficiency and inflammation

“…Anemia in the elderly can also be the consequence of a reduction in bone marrow functional reserve (Lipschitz et al, 1984), an adaptation to the reduction of the body lean mass with diminished oxygen requirements (Forbes & Halloran, 1976), or due to a reduced erythropoietin secretion (Kario et al, 1992). Elderly subjects living at home have a lower prevalence of anemia than institutionalized older patients (Salive et al, 1992).…”

Bone density and hemoglobin levels in older persons: results from the InCHIANTI study

“…The reported decrease in hemoglobin concentrations that occur during the aging process might be due to a lower erythropoietin secretion [3] or a reduced hematopoietic reserve [4]. However, a strong association between anemia and comorbidity has also been shown, which has led to the recommendation that hemoglobin levels below normal ranges should always be investigated in clinical practice [5].…”

Pathophysiology of the aging kidney and therapeutic interventions

“…35 EPO levels are, however, unexpectedly suppressed in anemic elderly patients when compared with anemic young individuals, which suggests a blunted response to low hemoglobin levels. [36][37][38] Older women with osteoporosis and mild renal dysfunction exhibit lower calcium absorption rates and lower serum 1,25-dihydroxyvitamin D levels despite normal serum 25-hydroxyvitamin D levels, indicating a deficiency in the conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D by the aging kidneys. 39 Mild renal dysfunction (creatinine clearance less than 65 ml min À1 ) is an independent risk factor for falls and their associated fractures in older patients with osteoporosis.…”