Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging?

Area of Science:

• Hematology
• Public Health
• Geriatrics

Background:

• Anemia is a significant global health issue with varying normal hemoglobin (Hb) levels based on sex, ethnicity, and physiological status.
• The aging population, particularly in Western countries, is experiencing a rise in anemia, often mild and defined by Hb <12 g/dL in both sexes.
• Anemia is multifactorial, necessitating consideration of hematologic parameters, pathological mechanisms, and patient history for accurate diagnosis.

Purpose of the Study:

• To highlight the global prevalence and diagnostic complexities of anemia.
• To emphasize the specific challenges and pathophysiology of anemia in the elderly population.
• To discuss the concept and potential causes of unexplained anemia.

Main Methods:

• Review of World Health Organization (WHO) anemia definitions and normal Hb variations.
• Analysis of anemia's contribution to morbidity and mortality in the elderly.
• Categorization of anemia causes, including nutritional deficiencies, chronic disease, and unexplained factors.

Main Results:

• Anemia diagnosis requires individualized Hb level considerations beyond general WHO guidelines.
• In the elderly, mild anemia is common and contributes to significant morbidity and mortality.
• Nutritional deficiencies and anemia of chronic disease each account for approximately one-third of anemia cases, with the remaining third classified as unexplained.

Conclusions:

• Accurate anemia diagnosis and classification require a comprehensive approach integrating various patient factors.
• Understanding the pathophysiology of unexplained anemia, potentially linked to erythropoietin resistance and inflammation, is crucial for the elderly.
• Anemia management strategies must address its diverse etiologies and impact on elderly health outcomes.