[Anemia in the elderly - a diagnostic and therapeutic challenge?]

Anemia in elderly patients should never be regarded as a normal physiological response to aging. The main categories of anemia in older patients are the nutritional anemia attributed to iron deficiency, including blood loss, folate and vitamin B12 deficiency, anemia of chronic disease in patients with cancer, infections and other chronic inflammation. A further category is the unexplained anemia due most probably to impaired corrective mechanisms to stress in older persons. Investigations such as a complete blood count, red cell indices and morphology, reticulocyte count, iron parameters, vitamin B12 and folate will detect the underlying disease in many cases, when anemia is classified according to red blood cell mean corpuscular volume. Microcytic anemia is typically for iron deficiency, but normocytic anemia can also be found in iron deficiency or anemia of chronic disease. Anemia due to vitamin B12 or folate deficiency is typically macrocytic. The treatment should aim to correct the underlying cause of disorder. Recombinant human erythropoietin is a standard treatment in anemia associated with chronic renal failure and tumor-associated anemia, but not in other forms of anemia. Regular blood transfusions may be required for elderly patients with chronic anemia.