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The Anaemias

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry

Abstract

Haemopoietic stem cells (HSCs) are responsible for the production and replenishment of major lineages of blood and immune cells throughout life. There is an age-related decline in haemoglobin from age 70 to 88 among healthy men and less marked in women. This review discusses the pathogenesis of the anaemias and their clinical manifestations and presents an algorithm for their evaluation and management. Anaemias may result from blood loss, inadequate red cell production and excessive red cell destruction. The review provides an overview of the common types of anaemias in the elderly, the iron deficiency anaemia, anaemia of chronic disease and vitamin B12 and folic acid deficiencies and their mechanisms and clinical management. An elderly presenting with iron deficiency is almost exclusively due to blood loss from the gastrointestinal tract. A wide variety of iron preparations are available. Parenteral iron therapy is safe and effective in iron deficiency anaemia. Anaemia of chronic disease (ACD) also referred to as anaemia of chronic inflammation (ACI) is the most common form of anaemia in the elderly, and several diseases (acute and chronic infections, inflammatory disorders and neoplasms) are associated with ACD. Many old people suffer from a deficiency of vitamin B12 (cobalamin). Many neurological and psychiatric symptoms may occur, alone or in association with the haematological abnormalities, and may be present in the absence of anaemia.

Keywords

Haemopoietic stem cells Iron deficiency anaemia Anaemia of chronic disease Vitamin B12 deficiency 

References

  1. 1.
    Fuller J. Hematopoietic stem cells and aging. Sci Aging Knowledge Environ. 2002;2002(25):pe11 http://www.ncbi.nim.gov/pubmed/14602993.
  2. 2.
    Wagner W, Horn P, Bork S, Ho AD. Aging of hematopoietic stem cells is regulated by the stem cell niche. Exp Gerontol. 2008;43(11):974–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Woolthuis CM, de Haan G, Huls G. Aging of haematopoietic stem cells: Intrinsic changes or micro-environmental effects? Curr Opin Immunol. 2011;23:512–517.CrossRefPubMedGoogle Scholar
  4. 4.
    Chambers SM, Shaw CA, Gatza C, Fisk J, Donehower LA, Gooell MA. Aging hematopoietic stem cells decline in function and exhibit epigenetic dysregulation. PLOS Biology. http://dx.doi.org/10.1371/journal.pbio.0050201.
  5. 5.
    Kuranda K, Vargeftig J, de la Rochere P, Dosquit C, Charron D, Bardin F, et al. Aging Cell. 2011;10(5):542–546.CrossRefPubMedGoogle Scholar
  6. 6.
    Gazil R, Weissman IL, Rossi DJ. Haematopoietic stem cells and aging haematopoietic system. Semin Haematol. 2008;45(4):218–24.CrossRefGoogle Scholar
  7. 7.
    Snoeck HW. Aging of the hemopoietic system. Curr Opin Hematol. 2013;20(4):355–61.CrossRefPubMedGoogle Scholar
  8. 8.
    Geiger H, de Haan G, Florian CM. The ageing haematopoietic stem cell compartment. Nature Rev Immunol. 2013;13:376–389.CrossRefGoogle Scholar
  9. 9.
    Nilsson-Ehle H, Jagenburg R, Landahl S, Svanborg A. Blood haemoglobin declines in the elderly: implications for reference intervals from age 70 to 88. Eur J Haematol. 2000; 65:297–305.CrossRefPubMedGoogle Scholar
  10. 10.
    Nagasawa T, Omatsu Y Sugiyama T. Control of hemopoietic stem cells by the bone marrow stromal niche: the role of reticular cells. Trends Immunol. 2011;32(7):315–20.CrossRefPubMedGoogle Scholar
  11. 11.
    Warren LA, Rossi DJ. Stem cells and aging in the haematopoietic system. Mech Ageing Dev. 2006;130:46–53.CrossRefGoogle Scholar
  12. 12.
    Gordon SR, Smith RE, Power GC. The role of endoscopy in the evaluation of iron deficiency anemia in patients over the age of 50. Gastroenterol. 1994;89:1963–7.Google Scholar
  13. 13.
    Rockey CD, Cello JP. Evaluation of the gastrointestinal tract in patients with iron deficiency anaemia. N Engl J Med. 1993;329:1691–5CrossRefPubMedGoogle Scholar
  14. 14.
    Nagaratnam N. Treatment of iron deficiency anaemia. Formulary Notes 1970;52:31–39. Government Press. Sri Lanka.Google Scholar
  15. 15.
    Laman CA, Silverstein SB, Rodgers GM. Parenteral iron therapy: a single institution’s experience over a 5-year period. J Natl Compr Canc Network. 2005;3(6):792–5.Google Scholar
  16. 16.
    Nissenson AR, Lindsay RM, Swan S, Seligman P, Strobos J. Sodium ferric gluconate in sucrose is safe and effective in hemodialysis patients: North American Trial. Am J Kidney Dis. 1999;33(3):471–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Burns DL, Pomposelli JJ. Risks and side effects of iron therapy. Kidney Int.1999;55:S119- S124.CrossRefGoogle Scholar
  18. 18.
    Ferrucci L Corsi A, Laurentani F, Bandinelli S, Bartali B, Taub DD, et al. The origin of age-related proinflammatory state. Blood. 2005;105:2294–2299.CrossRefPubMedGoogle Scholar
  19. 19.
    Cook JD, Finch CA, Smith NJ. Evaluation of iron states of a population. Blood 1976;48:49–58.Google Scholar
  20. 20.
    Stauder R, Thein SL. Anemia in the elderly: clinical implications and new therapeutic concepts. Haematologica. 2014;99(7):1127–130.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Goncalvesova E, Vahancik A, Cdernak P. Significance of laboratory examination in the diagnosis of iron deficiency anaemia in older persons. Vntr Lek. 1992;38:1201–7.Google Scholar
  22. 22.
    Shine JW. Microcytic anaemia. Am Fam Physician 1997;55(7):2455–62.PubMedGoogle Scholar
  23. 23.
    Wynn M, Wynn A. The danger of B12 deficiency in the elderly. Nutr Health. 1998;12:215–26.CrossRefPubMedGoogle Scholar
  24. 24.
    Daharmarajan TS, Norkus EP. Vitamin B12 deficiency in the elderly-population based research. In Herbert V, ed (1), pp 27–34, London: Royal Society of Medicine Press. 1999.Google Scholar
  25. 25.
    Stabler SP, Lindenbaum J, Allen RH. Vitamin B12 deficiency in the elderly: current dilemmas. Am J Clin Nutr. 1997; 66(4);741–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Dharmarajan TS, Ugalino JT, Kanagala M, Pitchumoni S, Norkus EP. Vitamin B12 status in hospitalized elderly from nursing homes and the community. J Am Med Dir Assoc. 1999; 99(6):725–7.Google Scholar
  27. 27.
    Eggersten R. Prevalence and diagnosis of cobalamin deficiency in older people. J Am Geriatr Soc. 1996;44(10) 1273–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Lindenbaum J, Rosenberg IH, Wilson PW, Satbler SP, Allen RH. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr. 1994;60:2–11.CrossRefPubMedGoogle Scholar
  29. 29.
    Allen LH, Casterline J. Vitamin B12 deficiency in the elderly individuals: diagnosis and requirements. Am J Clin Nutr. 1994;60:12–14.CrossRefPubMedGoogle Scholar
  30. 30.
    Dharmarajan TS, Norkus EP. Approaches to vitamin B12 deficiency. Postgraduate Medicine. 2001;110(1):99–105.CrossRefPubMedGoogle Scholar
  31. 31.
    Savage DG, Lindenbaum J, Stabler SP, Allen RH. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med. 1994;96:239–46.CrossRefPubMedGoogle Scholar
  32. 32.
    Joosten E, van den Berg A, Riezler R, Naurath HJ, Lindenbaum J, Stabler SP, et al, Metabolic evidence that deficiency of vitamin B12 (cobalamin), folate and vitamin B-6 occur commonly in elderly people. J Clin Nutrition. 1993;58(3): 468–76.CrossRefGoogle Scholar
  33. 33.
    Snow CF. Laboratory diagnosis of vitamin B12 and folate deficiency. Arch Intern Med. 1999; 159:128–98.CrossRefGoogle Scholar
  34. 34.
    Farrell CJ. Vitamin B12 and folate tests: interpret with care. MJA. 2013; 198(11):589PubMedGoogle Scholar
  35. 35.
    Farrell CJ, Kirch SH, Herrmann M. Red cell or serum folate: what to do in clinical practice? Clin Chem Lab Med. 2013;51:555–569.CrossRefPubMedGoogle Scholar
  36. 36.
    Willis CD, Metz MP, Hiller JE, Elshaug AG. Vitamin B12 and folate tests: the ongoing need to determine appropriate use and pubic funding. MJA. 2013;198(11): 586–588.PubMedGoogle Scholar
  37. 37.
    Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmlgarn BR. Impact of anemia on hospitalization and mortality in older adults. Blood. 2006;107:3841–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Balducci L, Ershler WB, Krantz S. Anemia in the elderly-Clinical findings and impact on health. Oncol Haematol. 2006;58(2):156–165.Google Scholar
  39. 39.
    Woodman R, Ferrucci L, Guralnik J. Anemia in older adults. Curr Opin Hmatol. 2005;12(2):123–8.Google Scholar
  40. 40.
    Mitrachi C, Passweg JR, Libura J, Petrikkos L, Seiler WO, Gratwohl A, et al. Anaemia: a indicator for malnutrition in the elderly. Ann Hematol. 2001;80(5):295–8.CrossRefGoogle Scholar
  41. 41.
    Busti F, Campostrini N, Martinelli N, Girelli D. Iron deficiency in the elderly population, revisited in the hepcidin era. Front Pharmacol. 2014;5:83.  https://doi.org/10.3389/fphar.2014.00083.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Patel KV, Gualnik JM. Prognostic implications of anaemia in older adults. Haematologica. 2009;94(1):1–2.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Vanasse GJ, Berliner N. Anaemia in elderly patients: an emerging problem for the 21st century. ASH Education Program Book. 2010; 2010 1:271–275.  https://doi.org/10.1182/asheducation-2010.1.271.Google Scholar
  44. 44.
    Haves PH. Functional outcomes of anemia in older adults. Semin Hematol. 2008;45(4)255–60.CrossRefGoogle Scholar
  45. 45.
    Denny SD, Kuchibhatla MN, Cohn HJ. Impact of anemia on mortality, cognition and function in community dwelling elderly. Am J Med. 2006;119(4):327–34.CrossRefPubMedGoogle Scholar
  46. 46.
    Beghe C, Wilson A, Ersler WB. Prevalence and outcomes in geriatrics: a systematic review of the literature. Am J Med. 2004;116(Supl 7A): 3S–10S.CrossRefPubMedGoogle Scholar
  47. 47.
    Viana MB. Anaemia and infection: a complex relationship. Rev Bras Hmatol Hemoter. 2011;33(2):90–92.CrossRefGoogle Scholar
  48. 48.
    Artz S. Anaemia in the frail elderly. Semin Haematol. 2008;45(4):261–6.CrossRefGoogle Scholar
  49. 49.
    Sabol VK, Resnick B, Galk E, Gruber –Baldini A, Morton PG, Hicks GE. Anemia and its impact in nursing home residents. what do we know? J Am Acad Nurs Pract. 2010;22(1):3–16.CrossRefGoogle Scholar
  50. 50.
    Peninx BW, Pahor M, Woodman RC, Guralnik JM. Anemia in old age is associated with increased mortality and hospitalisation. J Gerontol A Biol Sci Med Sci. 2006;61:474–9.CrossRefGoogle Scholar
  51. 51.
    Riva E, Tettamanti M, Mosconi P, Apolone G, Gandini F, Nobili A, et al. Association of mild anemia with hospitalization and mortality in the elderly: The Health and Anemia population-based study. Hematologica. 2009;94:22–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

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