A Study of Severe Anemia in Elderly with Special Reference to Etiology

International Journal of Medical Science

© 2020 by SSRG - IJMS Journal

Volume 7 Issue 11

Year of Publication : 2020

Authors : Dr. Antarikhya Bordoloi, Dr. Sayali Suhas Damle

10.14445/23939117/IJMS-V7I11P103

How to Cite?

Dr. Antarikhya Bordoloi, Dr. Sayali Suhas Damle, "A Study of Severe Anemia in Elderly with Special Reference to Etiology," SSRG International Journal of Medical Science, vol. 7,  no. 11, pp. 14-18, 2020. Crossref, https://doi.org/10.14445/23939117/IJMS-V7I11P103

Abstract:

This study was a prospective, observational study conducted over two years in a tertiary care hospital in Navi Mumbai, India, to study severe Anemia in the elderly with a special reference to etiology. Owing to India's increasing elderly population, Anemia in the elderly is a common condition that is vastly overlooked. The study included 50 individuals with severe Anemia (Hb less than 8g/dL), with an age more than or equal to 60 years. Our study's age varied from 60 to 82 years, with maximum patients from 60 to 65. Easy fatigability was present in 80% of patients, followed by anorexia, tiredness, breathlessness, and pedal edema. Generalized weakness, black colored stools, jaundice, headache, dysphagia, intermittent claudication, giddiness, and lower limb weakness and paresthesia were some other symptoms experienced by these patients. The most common type of Anemia among elderly patients, as found through this study, was microcytic hypochromic, followed by normocytic normochromic, dimorphic, and macrocytic hyperchromic Anemia. Severe Anemia in the elderly had varied manifestations.

Keywords:

Anemia, Atypical, Elderly, Etiology, Haemoglobin, Fatiguability

References:

[1] World Health Organization Deficiency Anemia: Assessment, Prevention, and Control. Geneva. World Health Organization; 200.
[2] Haemoglobin Concentration for the Diagnosis of Anemia and Assessment of Severity, the World Health Organization
[3] Red Blood Cells and Bleeding Disorders, Robbins Basic Pathology, 8th Edition, Chapter 14, 659-662
[4] Nancy C. Andrews, Iron Deficiency and Related Disorders, Wintrobes Clinical Haematology, 12th Edition, Chapter 27, 812.
[5] Green R, Charlton R, Seftel H, et al., Body Iron Excretion in Men: A Collaborative Study, AM J Med, 1968; 45:336-353
[6] Hallberg L, Hogdahl AM, Nilsson L, Rybo G, Menstrual Blood Loss – A Population Study, Variation at Different Ages and Attempts to Define Normality. Acta Obstet Gynecol Scand, 1966 ; 45 : 320 – 351.
[7] Hallberg L, Rossander-Hulten L, Iron Requirements in Menstruating Women, Am J Clin Nutr 1991; 54:1047 – 1058
[8] Beutler E, Iron Therapy in Chronically Fatigued Non-Anemic Women, Ann Intern Med 1960; 52: 378.
[9] Robert T, Means Jr., Bertil Glader, Anemia General Considerations, Wintrobes Clinical Haematology, 12th Edition, Chapter 26, 787
[10] Herbert B, Experimental Nutritional Folate Deficiency in Men, Trans Assoc AM Physicians 1962; 75: 307 – 320.
[11] Nath BJ, Lindenbaum J, Persistence of Neutrophil Hyper segmentation During Recovery from Megaloblastic Granulopoiesis, Ann Intern Med 1979; 90 (5): 757 – 760.
[12] Lindenbaum J, Healton EB, Savage DG, et al., Neuropsychiatric Disorders Caused by Cobalamine Deficiency in the Absence of Anemia or Macrocytosis, N Engl J Med 1988; 318: 1720 – 1728.
[13] Carmel R, Pernicious Anemia: The Expected Findings of Very Low Serum Cobalamine Levels, Anemia and Macrocytosis are often Lacking, Arch Intern Med 1988; 148: 1712 – 1714.
[14] Healton EB, Savage DG, Brust JC, et al., Neurologic Aspects of Cobalamine Deficiency, Med 1991; 70: 229 – 245.
[15] Savage D, Lindenbaum J, Relapses After Interruption of Cyanocobalamine Therapy in Patients with Pernicous Anemia, Am J Med 1983; 74: 765 – 772.
[16] Magnus EN, Cobalamine and Unsaturated Trans Cobalamine Values in Pernicious Anemia: Relation to Treatment, Scand J Haematol 1986; 36: 457 – 465.
[17] Crosby W, Akeroyd JH, The Limit of Haemoglobin Synthesis in Hereditary Anemia, Am J Med 1952; 13: 273 – 283.
[18] Ham T, Hemoglobinuria, Am J Med 1955; 18: 990 – 1006.
[19] Dawson AA, Ojston D, Fullerton HW, Evaluation of Diagnostic Significance of Certain Symptoms and Physical Signs in Anemic Patients, BMJ 1969; 3 (668): 436 – 439.
[20] Bartels E, Anemia as the Cause of Severe Congestive Heart Failure: Report of a Case, Annals of Internal Medicine 1937; 11: 400 – 404.
[21] Pickering G, Wayne EJ, Observations on Angina Pectoris and Intermittent Claudication in Anemia, Clinical Science 1933; 1: 305 – 325.
[22] Varat MA, Adolf RJ, Fowler NO, Cardiovascular Effects of Anemia, American Heart Journal 1972; 83 (3): 415 – 426.
[23] Marshall R, A Review of Lesions on the Optic Fundus in Various Diseases of the Blood, Blood 1959; 14: 882 – 891.
[24] Aisen ML, et al., Retinal Abnormalities Associated with Anemia, American Academy of Opthalmology 1983; 101 (7): 1049 – 1052.
[25] Merin S, Freund M, Retinopathy in Severe Anemia, American Journal of Ophthalmology 1968; 66 (6): 1102 – 1106.
[26] Schaber J, Blumberg AG, Papilledema Associated with Blood Loss Anemia, Annals of Internal Medicine 1961; 55: 1004 – 1007.
[27] Robert T, Means Jr., Bartil Glader, Anemia General Considerations, Wintrobes Clinical Haematology, 12th Edition, Chapter 26, 801.
[28] Consensus Conference, Peri-operative Red Blood Cell Transfusion, JAMA 1988; 260 (18): 2700 – 2703.
[29] Practice Strategies for Elective Red Blood Cell Transfusion, American College of Physicians, Ann Intern Med 1992; 116 (5): 403 – 406.
[30] Practice Guidelines for Blood Component Therapy: A Report by the American Society of Anaesthesiology 1996; 84 (3): 732 – 747.
[31] Expert Working Group: Guidelines for Red Blood Cell and Plasma Transfusion for Adults and Children, CAN Med Assoc. J 1997 (11 Suppl.); S1 – S24.
[32] Welch HG, Meehan KR, Goodnough LT, Prudent Strategies for Elective Red Blood Cell Transfusion, Ann Intern Med 1992; 116 (5): 393 – 402.
[33] Hebert PC, Wells G, Blajchman MA, et al., A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care, Transfusions Requirements in Critical Care Investigators, Canadian Critical Care Trials Groups, N Engl. J Med 1999; 340 (6): 409 – 417.
[34] Vincent JL, Baron JF, Reinhart K, et al. Anemia and Blood Transfusion in Critically Ill Patients, JAMA 2002; 288 (12): 1499-1507.
[35] Wu WC, Rathore SS, Wang Y, et al. Blood Transfusion in elderly patients with acute myocardial infarction, N Engl. J Med 2001; 345 (17): 1230 – 1236.
[36] Ross S, Jeter E. Emergency Surgery: Trauma and Massive Transfusion. In: Petz LD, Kleinman S, Swisher SN, et al., eds. Clinical Practice of Transfusion Medicine, 3rd ed. New York: Churchill Livingstone, 1996: 563 – 579.
[37] Carson JL, Duff A, Berlin JA, et al. Perioperative Blood Transfusion and Postoperative Mortality, JAMA 1998; 279 (3): 199 – 205.
[38] Groopman J.E., Itri KM, Chemotherapy-induced Anemia in Adults: Incidence and Treatment, J Natl Cancer Inst 1999; 91 (19):1616 – 1634
[39] Petz LD, Blood Transfusion in Acquired Hemolytic Anemias, In Petz LD, Kleinman S, Swisher SN, et al., eds. Clinical Practice of Transfusion Medicine, 3rd ed. New York: Churchill Livingstone, 1996: 469 – 499.
[40] Petz LD, Garratty G, Blood Transfusion in Autoimmune Hemolytic Anemia. In: Immune Hemolytic Anemias, 2nd ed. Philadelphia: Churchill Livingstone, 2004: 375 – 400.
[41] Grebe G, Martizez-Torres C, Layrisse M, Effect of Meals and Ascorbic Acid on the Absorption of a Therapeutic Dose of Iron as Ferrous and Ferric Salts, Curr Ther Res Clin Exp 1975; 17: 382 – 397.
[42] Crosby WH, The Rationale for Treating Iron Deficiency Anemia. Arch Intern Med 1984; 144: 471 – 472.
[43] Cacciola E, Witt D, Toler W, et al., Ascorbic Acid Deficiency may be a Cause of Refractoriness to Iron-Therapy in the Treatment of Iron-Deficiency Anemia, Haematologica 1994; 79: 96-97.
[44] Nath BJ, Lindenbaum J, Persistence of Neutrophil Hyper-segmentation during Recovery from Megaloblastic Granulopoiesis, Ann Intern Med 1979; 90: 757 – 760
[45] Marshall A Litchman, Thomas J Kipps, Folate, Cobalamine and Megaloblastic Anemias, Williams Hematology 8th edition (2010), Chapter 41.
[46] Temple RM, Deary IJ, Winney RJ, Recombinant Erythropoietin Improves Cognitive Function in Patients Maintained in Chronic Ambulatory Peritoneal Dialysis, Nephrol Dial Transplant 1995; 10: 1733 – 1738.
[47] Mayer G, Thum J, Cada Em, et al., Working Capacity is increased following recombinant human erythropoietin treatment, Kind Int. 1988; 34: 525 – 528.
[48] Lago M, Perez-Garcia R, De VMSG, et al., Efficiency of Once-Weekly Subcutaneous Administration of Recombinant Human Erythropoietin Versus Three times a Week Administration in Hemodialysis Patients, Nephron 1996; 72: 723 – 724.
[49] Eschbach JW, Abdulhadi MH, Browne JK, et al., Recombinant Human Erythropoietin in Anemic Patients with End-Stage Renal Disease: Results of a Phase III Multicenter Trial, Ann Intern Med 1989; 111: 992 – 1000.
[50] Jones MA, Kingswood HC, Dallyn PE, et al., Changes in diurnal blood pressure variation and red cell and plasma volumes in patients with renal failure who develop erythropoietin-induced hypertension, Clin Nephrol 1995; 44: 193 – 200.