Unexplained Anemia in the Elderly

Anemia is frequently diagnosed in elderly patients, and it is a key indicator of many reactive and clonal conditions. Furthermore, the older age is the most common presenting age for myelodysplastic syndromes (MDS). Anemia in older age may be attributed to an inflammatory state due to senescence, comorbidities, nutritional deficiencies, or primary bone marrow conditions. As diagnostic possibilities and life expectancy increase, the prevalence of anemia of the elderly increases as well. The etiology has a direct impact on the treatment and quality of life of these patients, in whom is a usual clinical challenge as it may be due to a multifactorial origin. In a minority group, when no etiology is identified, it is classified as unexplained anemia (UA) or clonal cytopenia of unknown significance (CCUS). The underlying cause of anemia remains unexplained in 30% of cases, and a great part of unexplained cytopenia may account for myeloid neoplasms. Anemia in the elderly is associated with worse cognitive and functional outcomes and increased mortality.