Anemia in the elderly: an important clinical problem

A paper written by Sgnaolin et al. (1) is published in this issue of the Revista Brasileira de Hematologia e Hemoterapia. The authors present a study about the frequency of anemia of 1058 people of 60 years old or more living in a community-based population in Porto Alegre, Brazil. Blood samples were taken from all participants and the hematological parameters [hemoglobin, mean cell volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW)] were analyzed. They observed a frequency of anemia of 12.8%, which was higher in women than in men. The majority of anemic patients presented with normocytic and normochromic anemia, but when they evaluated the erythrocyte morphology the anemic population had almost 10 times more microcytosis than the non-anemic subjects. This is a very important clinical problem as the frequency of anemia in this population can range from 10 to 30%. The large National Health and Nutrition Examination Survey (NHANES III) population study (2) showed that the prevalence of anemia increases directly with age; it is 10 to 11% in over 65-year olds and jumps to 26 to 30% in over 75-year olds and is a little higher in men (2-4). The frequency of anemia can be even higher in patients followed in outpatient clinics due to the increase in different diseases these patients have. An abstract presented in the 2012 Brazilian Congress of Hematology by this author showed a frequency of 36.5% in 96 elderly patients with ages ranging from 65 to 92 years (mean: 76 years) followed in an outpatient clinic (5). The symptoms as dyspnea, angina and fainting are more intense in the elderly and the presence of comorbidities exacerbate the consequences of anemia in this population. It is relevant to comment that in the elderly, the lower the level of hemoglobin the higher the morbidity, mainly in those who have heart disease. It has been reported that the mortality of over 60-year-old patients, with myocardial infarction in an intensive care unit was higher when hemoglobin levels were lower. Moreover, the use of erythropoietin and transfusions in these patients reduced the mortality rate (6-9). Anemia significantly affects the daily performance of elderly patients. Some studies show that the capacity of walking, standing up, sitting or getting up from a chair and taking objects is severely impaired in anemic patients (10,11). An assessment of the quality of life also shows the negative effects …