Unexplained Anemia in the Elderly

Makipour, Sasan; Kanapuru, Bindu; Ershler, William B.

doi:10.1053/j.seminhematol.2008.06.003

Cited by 94 publications

(65 citation statements)

References 58 publications

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“…Causes of anemia in addition to ADT in men with prostate cancer include: bone marrow infiltration from metastatic prostate cancer, treatment-related myelotoxicity (radiation, chemotherapy), radiation proctitis or cystitis, anemia of chronic disease, inflammatory cytokines, hematuria, poor nutrition and an agerelated increase in susceptibility to anemia. 52 In addition, hemoglobin should be measured at regular intervals in patients receiving ADT, although frequency of hemoglobin measurements need to be individualized according to symptoms and baseline hemoglobin level.…”

Section: Evaluation Of Adt-associated Anemiamentioning

confidence: 99%

Hematological changes during androgen deprivation therapy

Grossmann¹,

Zajac²

2012

Asian J Androl

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Androgen deprivation therapy (ADT) has been associated with a plethora of adverse effects, consistent with the androgen dependency of multiple reproductive and somatic tissues. One such tissue is the hemopoietic system, and one of the most predictable consequences of ADT is the development of anemia. Although anemia caused by ADT is rarely severe, ADT is often given to frail, elderly men with increased susceptibility to anemia due to multiple other causes. ADT-associated anemia may contribute to fatigue and reduced quality of life (QoL) in such men, although this requires further study. While anemia is an independent risk factor of mortality in men with prostate cancer, it is not known whether treatment of ADT-associated anemia alters clinically important outcomes, or whether treatment affects mortality. Awareness of the phenomenon of ADT-induced anemia should avoid unnecessary work-up in mild cases of normocytic normochromic anemia. However, assessment and treatment of more severe anemia may be required. This should be determined on an individual basis. In contrast to the well-described actions of ADT on erythropoiesis, its effect on other hemopoietic lineages has been less well elucidated. While preclinical studies have found roles for androgens in maturation and differentiated function of neutrophils, lymphocytes and platelets, the implications of these findings for men with prostate cancer receiving ADT require further studies.

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Section: Evaluation Of Adt-associated Anemiamentioning

confidence: 99%

Hematological changes during androgen deprivation therapy

Grossmann¹,

Zajac²

2012

Asian J Androl

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“…The Third National Health and Nutrition Examination Survey (NHANES III) reported the prevalence of WHO defined anemia among community dwelling adults of age 65years and older to be 11% and 10% in men and women respectively. The prevalence of anemia was also observed to increase with advancing age and among the oldest old (85 years and older), it was present in 29.3-30.7% of men and in 16.5-17.7% of women [4][5][6].…”

Section: Prevalence Of Anemia In the Elderlymentioning

confidence: 93%

Are Blood Transfusions Useful for Non-Specific Symptoms of Anemia in the Elderly?

Raza¹,

Wei²,

Abid³

et al. 2014

MEDJ

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Abstract:Background: Over 10% of adults older than 65 years have World Health Organization defined anemia (Hemoglobin lower than13 g/dl in men and 12 g/dl in women). It is more prevalent with increasing age, exceeding 20% in the very elderly (85 years and older). Typical symptoms of anemia are nonspecific and often attributed to aging or to an exacerbation of another illness in the elderly. Methods:We present a case series of patients between ages 65-99 years who were followed at the Senior Health clinic and presented with nonspecific symptoms. All these patients were found to have life-threatening anemia requiring blood transfusions.Design: Case series.Results: All our elderly patients experienced good outcomes in terms of resolution of their symptoms and improvement in functional status. There was a significant difference in the total number of symptoms pre-transfusion compared with symptoms post-transfusion (p < 0.01). There were no adverse outcomes. Conclusion:Our case series suggests that symptoms of anemia in the elderly are often attributed to aging or other disease co-morbidities. Nonspecific symptoms like dyspnea, fatigue and confusion should not be ignored. Management decisions regarding anemia should involve functional assessment of the elderly subject. Immediate arrangements for transfusion must be made if the elderly patient is symptomatic regardless of the hemoglobin level. If monitored appropriately, blood transfusions can prolong survival, improve quality of life and functional status of the older individual.

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“…Importantly, these various causes of anaemia may coexist in the same patient, leading to diagnostic difficulty. In a significant proportion, anaemia may remain unexplained despite appropriate investigation [10,11].…”

Section: Introductionmentioning

confidence: 99%

Targeting, Monitoring and Effect of Oral Iron Therapy on Haemoglobin Levels in Older Patients Discharged to Primary Care from Inpatient Rehabilitation: A Cohort Study Using Routinely Collected Data

2016

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Targeting, monitoring and effect of oral iron therapy on haemoglobin levels in older patients discharged to primary care from inpatient rehabilitation Thomson, Zach; Hands, Katherine J.; Witham, Miles , & Witham, M. (2016). Targeting, monitoring and effect of oral iron therapy on haemoglobin levels in older patients discharged to primary care from inpatient rehabilitation: a cohort study using routinely collected data. Drugs & Aging, 33(8), 603-610. DOI: 10.1007/s40266-016-0385-y General rightsCopyright and moral rights for the publications made accessible in Discovery Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from Discovery Research Portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain.• You may freely distribute the URL identifying the publication in the public portal. Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract BackgroundOral iron is commonly prescribed to older patients with suspected or confirmed iron deficiency anaemia, however few studies have examined the effectiveness of oral iron therapy in the real world in this population. We therefore determined the prevalence of iron deficiency in older people prescribed oral iron, examined the response mounted to therapy and ascertained predictors of response to oral iron. MethodsWe analysed a routinely collected, linked dataset from older patients who had undergone inpatient rehabilitation between 1999 and 2011. An initial analysis examined patients within this cohort who were prescribed iron after rehabilitation and derived three groups based upon their ferritin and transferrin indices; probably, possibly and not iron deficient. A second analysis compared pre-and post-treatment haemoglobin to determine the degree of response to iron therapy across each category of deficiency. Finally, patient demographics, linked biochemistry data and comorbid disease based on International Statistical Classification of Disease (ICD-10) codes from previous hospital admissions were used in regression modelling to evaluate factors affecting response to therapy. Results490 patients were prescribed oral iron within 90 days of rehabilitation discharge. 413/490 (84%) had iron indices performed; 94 (23%) were possibly deficient, 224 (54%) were probably deficient, and 95 (23%) were not deficient. 360/490 patients had both pre and post treatment haemoglobin data and iron indices; probably deficient patients mounted a slightly greater response to oral iron (17g/L vs 12g/L for not deficient; p<0.05). Only pre-treatment haemoglobin, mean cell volume (MCV) and lower gastrointestinal pathology were significant predictors ...

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Unexplained Anemia in the Elderly

Cited by 94 publications

References 58 publications

Hematological changes during androgen deprivation therapy

Hematological changes during androgen deprivation therapy

Are Blood Transfusions Useful for Non-Specific Symptoms of Anemia in the Elderly?

Targeting, Monitoring and Effect of Oral Iron Therapy on Haemoglobin Levels in Older Patients Discharged to Primary Care from Inpatient Rehabilitation: A Cohort Study Using Routinely Collected Data

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