Microcytic anemia in older adults: a comprehensive review

Microcytic anemia (MA) is common in older adults (OA) with a significant impact on quality of life and survival. We explore current knowledge on the subject.

Nonspecific general signs (delirium, cognitive disorders, apathy, bradyphrenia, falls, …) may be at the forefront of MA in OA.Recent advances have clarified the roles of hepcidin, ferroportin and soluble transferrin receptors. Nevertheless, the assay of these new biomarkers is only recommended in cases of uncertainty.The most common mechanism of MA in OA is iron deficiency. It is often both absolute (decrease in iron reserves) and functional (decrease in circulating iron, while reserves are high), particularly in frail OA characterized by polymorbidity/polypharmacy.The Haute Autorité de Santé (France) has published guidelines establishing a hemoglobin threshold for red blood cell transfusion in OA: <7 g/dl in the case of asymptomatic anemia, <8 g/dl if there is heart failure or coronary insufficiency, and <10 g/dl if there is poor clinical tolerance.Administration of intravenous furosemide after red blood cell transfusion is recommended to prevent transfusion-associated circulatory overload. Iron supplementation will also be prescribed in absolute deficiency.

Microcytic anemia, often mixed in OA, requires symptomatic and etiological management.