Approach to mild anemia in the elderly

There is evidence that indicates a physiologic decrease in bone marrow function as a part of aging, perhaps as an adjustment to a decrease in metabolic demand and tissue requirement for oxygen. In general, aging is associated with a decline in activity and an increase in chronic inflammatory as well as cardiovascular disorders. These alter not only red blood cell production but also plasma volume, leading to an increased frequency of a lower hemoglobin concentration and hematocrit level. However, there is resistance to using new geriatric norms for these hematologic parameters to define anemia, since the majority of patients without disease fall within the usual established ranges. Yet surveys have shown that there is no increase in iron deficiency with age, and the majority of elderly patients with mild anemia show no demonstrable cause and are unresponsive to therapy. The statement that anemia is often a presenting sign of a serious underlying illness and that patients with anemia must undergo a complete work-up should be reconsidered in the elderly, and the criteria for anemia should be redefined to prevent unnecessary studies for individuals who fall in the lower limits of normalcy because of age. This statement is supported by the results of long-term follow-up of patients in a geriatric care institution. A group of patients with mild anemia, without any apparent cause, who were often not examined thoroughly because of the relative mildness of symptoms and lack of progression, lived a satisfactory life and seem to be well adjusted to low hemoglobin levels. Asymptomatic elderly patients with mild anemia may not be anemic if we adjust the expected levels for the elderly. We can save 95 per cent of these patients from undergoing unnecessary testing.