Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-8kt4b Total loading time: 0 Render date: 2024-06-19T23:39:52.681Z Has data issue: false hasContentIssue false

Chapter 37 - Anemia and other hematological problems in the elderly

from Section III - Care of the elderly by organ system

Published online by Cambridge University Press:  05 June 2016

Jan Busby-Whitehead
Affiliation:
University of North Carolina
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Samuel C. Durso
Affiliation:
The Johns Hopkins University School of Medicine
Daniel Swagerty
Affiliation:
University of Kansas
Laura Mosqueda
Affiliation:
University of Southern California
Maria Fiatarone Singh
Affiliation:
University of Sydney
William Reichel
Affiliation:
Georgetown University, Washington DC
Get access

Summary

Hematologic abnormalities occur commonly in the elderly. The prevalence of anemia appears to increase with age and may be caused by various underlying etiologies, including iron deficiency, anemia of inflammation, or myelodysplastic syndrome. Thrombocytopenia due to underlying comorbidities, medications, or immune thrombocytopenia (ITP) may also occur. Underlying hematologic malignancies such as chronic lymphocytic leukemia (CLL) and multiple myeloma also become more prevalent with age. A systematic approach to the evaluation of these hematologic abnormalities is imperative to help guide diagnosis and management. For acute or progressive conditions, a multidisciplinary team of both geriatricians and hematologists is essential to ensure proper diagnosis, frailty assessment, and initiation of appropriate therapies. Novel therapies for the various hematological malignancies are well tolerated, turning life-threatening illnesses into chronic disease that can be managed while preserving quality of life.
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
, pp. 523 - 536
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blanc, B, Finch, C, Hallberg, L, et al. Nutritional anaemia: report of a WHO scientific group. WHO Tech Report Series 1968;405:537.Google Scholar
Zakai, NA, Katz, R, Hirsch, C, et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the Cardiovascular Health Study. Arch Intern Med 2005;165:2214–20.Google Scholar
Guralnik, JM, Eisenstaedt, RS, Ferrucci, L, et al. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 2004;104:2263–8.Google Scholar
Izaks, GJ, Westendorp, RG, Knook, DL. The definition of anemia in older persons. JAMA 1999;281:1714–7.Google Scholar
Artz, AS, Thirman, MJ. Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic. J Gerontol A Biol Sci Med Sci 2011;66:925–32.Google Scholar
Ferrucci, L, Semba, RD, Guralnik, JM, et al. Proinflammatory state, hepcidin, and anemia in older persons. Blood 2010;115:3810–6.CrossRefGoogle ScholarPubMed
Adler, AS, Kawahara, TL, Segal, E, Chang, HY. Reversal of aging by NFkappaB blockade. Cell Cycle 2008;7:556–9.Google Scholar
Chambers, SM, Shaw, CA, Gatza, C, et al. Aging hematopoietic stem cells decline in function and exhibit epigenetic dysregulation. PLoS Biol 2007;5:e201.Google Scholar
Chambers, SM, Goodell, MA. Hematopoietic stem cell aging: wrinkles in stem cell potential. Stem Cell Rev 2007;3:201–11.Google Scholar
Culleton, BF, Manns, BJ, Zhang, J, et al. Impact of anemia on hospitalization and mortality in older adults. Blood 2006;107:3841–6.Google Scholar
Zakai, NA, French, B, Arnold, AM, et al. Hemoglobin decline, function, and mortality in the elderly: the cardiovascular health study. Am J Hematol 2013;88:59.Google Scholar
Dong, X, Mendes de Leon, C, Artz, A, et al. A population-based study of hemoglobin, race, and mortality in elderly persons. J Gerontol A Biol Sci Med Sci 2008;63:873–8.Google Scholar
Denny, SD, Kuchibhatla, MN, Cohen, HJ. Impact of anemia on mortality, cognition, and function in community-dwelling elderly. Am J Med 2006;119:327–34.Google Scholar
Penninx, BW, Guralnik, JM, Onder, G, et al. Anemia and decline in physical performance among older persons. Am J Med 2003;115:104–10.Google Scholar
Penninx, BW, Pluijm, SM, Lips, P, et al. Late-life anemia is associated with increased risk of recurrent falls. J Am Geriatr Soc 2005;53:2106–11.Google Scholar
Chaves, PH, Semba, RD, Leng, SX, et al. Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women’s Health and Aging Studies I and II. J Gerontol A Biol Sci Med Sci 2005;60:729–35.CrossRefGoogle ScholarPubMed
Deal, JA, Carlson, MC, Xue, QL, et al. Anemia and 9-year domain-specific cognitive decline in community-dwelling older women: The Women’s Health and Aging Study II. J Am Geriatr Soc 2009;57:1604–11.Google Scholar
Zilinski, J, Zillmann, R, Becker, I, et al. Prevalence of anemia among elderly inpatients and its association with multidimensional loss of function. Ann Hematol 2014;93(10):1645–54.Google Scholar
Hong, CH, Falvey, C, Harris, TB, et al. Anemia and risk of dementia in older adults: findings from the Health ABC study. Neurology 2013;81:528–33.Google Scholar
Joosten, E, Ghesquiere, B, Linthoudt, H, et al. Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient. Am J Med 1999;107:24–9.Google Scholar
Pang, WW, Schrier, SL. Anemia in the elderly. Curr Opin Hematol 2012;19:133–40.Google Scholar
Cook, JD, Flowers, CH, Skikne, BS. The quantitative assessment of body iron. Blood 2003;101:3359–64.Google Scholar
Keel, SB, Abkowitz, JL. The microcytic red cell and the anemia of inflammation. N Engl J Med 2009;361:1904–6.Google Scholar
Rector, WG Jr. Pica: its frequency and significance in patients with iron-deficiency anemia due to chronic gastrointestinal blood loss. J Gen Intern Med 1989;4:512–3.Google Scholar
Moist, LM, Troyanov, S, White, CT, et al. Canadian Society of Nephrology commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. Am J Kidney Dis 2013;62:860–73.Google Scholar
Martin, A, Thompson, AA. Thalassemias. Pediatr Clin North Am 2013;60:1383–91.Google Scholar
Muncie, HL Jr, Campbell, J. Alpha and beta thalassemia. Am Fam Physician 2009;80:339–44.Google ScholarPubMed
Price, EA, Mehra, R, Holmes, TH, Schrier, SL. Anemia in older persons: etiology and evaluation. Blood Cells Mol Dis 2011;46:159–65.CrossRefGoogle ScholarPubMed
Corazza, F, Beguin, Y, Bergmann, P, et al. Anemia in children with cancer is associated with decreased erythropoietic activity and not with inadequate erythropoietin production. Blood 1998;92:1793–8.Google Scholar
Weiss, G, Goodnough, LT. Anemia of chronic disease. N Engl J Med 2005;352:1011–23.Google Scholar
Artz, AS, Xue, QL, Wickrema, A, et al. Unexplained anaemia in the elderly is characterised by features of low grade inflammation. Br J Haematol 2014;167(2):286–9.Google Scholar
Allen, LA, Felker, GM, Mehra, MR, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail 2010;16:230–8.Google Scholar
Roy, CN. Anemia of inflammation. Hematology Am Soc Hematol Educ Program 2010;2010:276–80.Google Scholar
Merchant, AA, Roy, CN. Not so benign haematology: anaemia of the elderly. Br J Haematol 2012;156:173–85.Google Scholar
Goodnough, LT, Levy, JH, Murphy, MF. Concepts of blood transfusion in adults. Lancet 2013;381:1845–54.Google Scholar
Finch, CA, Lenfant, C. Oxygen transport in man. N Engl J Med 1972;286:407–15.Google Scholar
Kazmi, WH, Kausz, AT, Khan, S, et al. Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis 2001;38:803–12.Google Scholar
Erslev, AJ. Erythropoietin. N Engl J Med 1991;324:1339–44.CrossRefGoogle ScholarPubMed
Donnelly, S, Shah, BR. Erythropoietin deficiency in hyporeninemia. Am J Kidney Dis 1999;33:947–53.Google Scholar
Ma, JZ, Ebben, J, Xia, H, Collins, AJ. Hematocrit level and associated mortality in hemodialysis patients. J Am Soc Nephrol 1999;10:610–19.Google Scholar
Fernandez-Rodriguez, AM, Guindeo-Casasus, MC, Molero-Labarta, T, et al. Diagnosis of iron deficiency in chronic renal failure. Am J Kidney Dis 1999;34:508–13.Google Scholar
Phrommintikul, A, Haas, SJ, Elsik, M, Krum, H. Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a meta-analysis. Lancet 2007;369:381–8.Google ScholarPubMed
Andres, E, Loukili, NH, Noel, E, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ 2004;171:251–9.Google Scholar
Carmel, R. How I treat cobalamin (vitamin B12) deficiency. Blood 2008;112:2214–21.Google Scholar
Nimo, RE, Carmel, R. Increased sensitivity of detection of the blocking (type I) anti-intrinsic factor antibody. Am J Clin Pathol 1987;88:729–33.Google Scholar
Eussen, SJ, de Groot, LC, Clarke, R, et al. Oral cyanocobalamin supplementation in older people with vitamin B12 deficiency: a dose-finding trial. Arch Intern Med 2005;165:1167–72.Google Scholar
Ades, L, Itzykson, R, Fenaux, P. Myelodysplastic syndromes. Lancet 2014;383:2239–52.Google Scholar
Will, B, Zhou, L, Vogler, TO, et al. Stem and progenitor cells in myelodysplastic syndromes show aberrant stage-specific expansion and harbor genetic and epigenetic alterations. Blood 2012;120:2076–86.Google Scholar
Anttila, P, Ihalainen, J, Salo, A, et al. Idiopathic macrocytic anaemia in the aged: molecular and cytogenetic findings. Br J Haematol 1995;90:797803.Google Scholar
Greenberg, PL, Tuechler, H, Schanz, J, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood 2012;120:2454–65.Google Scholar
Zeidan, AM, Linhares, Y, Gore, SD. Current therapy of myelodysplastic syndromes. Blood Rev 2013;27:243–59.Google Scholar
Gehrs, BC, Friedberg, RC. Autoimmune hemolytic anemia. Am J Hematol 2002;69:258–71.Google Scholar
Crisp, D, Pruzanski, W. B-cell neoplasms with homogeneous cold-reacting antibodies (cold agglutinins). Am J Med 1982;72:915–22.CrossRefGoogle ScholarPubMed
Berentsen, S. Cold agglutinin-mediated autoimmune hemolytic anemia in Waldenstrom’s macroglobulinemia. Clin Lymphoma Myeloma 2009;9:110–12.Google Scholar
Berentsen, S, Ulvestad, E, Langholm, R, et al. Primary chronic cold agglutinin disease: a population based clinical study of 86 patients. Haematologica 2006;91:460–6.Google Scholar
Smyth, SS, McEver, RP, Weyrich, AS, et al. Platelet functions beyond hemostasis. J Thromb Haemost 2009;7:1759–66.Google Scholar
Williamson, DR, Albert, M, Heels-Ansdell, D, et al. Thrombocytopenia in critically ill patients receiving thromboprophylaxis: frequency, risk factors, and outcomes. Chest 2013;144:1207–15.Google Scholar
Mendes, FD, Suzuki, A, Sanderson, SO, et al. Prevalence and indicators of portal hypertension in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2012;10(9):1028–33.Google Scholar
Sheikh, MY, Raoufi, R, Atla, PR, et al. Prevalence of cirrhosis in patients with thrombocytopenia who receive bone marrow biopsy. Saudi J Gastroenterol 2012;18:257–62.Google Scholar
Aster, RH. Pooling of platelets in the spleen: role in the pathogenesis of “hypersplenic” thrombocytopenia. J Clin Invest 1966;45:645–57.Google Scholar
Peck-Radosavljevic, M, Zacherl, J, Meng, YG, et al. Is inadequate thrombopoietin production a major cause of thrombocytopenia in cirrhosis of the liver? J Hepatol 1997;27:127–31.Google Scholar
Kuwana, M, Okazaki, Y, Ikeda, Y. Splenic macrophages maintain the anti-platelet autoimmune response via uptake of opsonized platelets in patients with immune thrombocytopenic purpura. J Thromb Haemost 2009;7:322–9.Google Scholar
Frederiksen, H, Schmidt, K. The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood 1999;94:909–13.Google Scholar
Neunert, C, Lim, W, Crowther, M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011;117:4190–207.Google Scholar
Cines, DB, Blanchette, VS. Immune thrombocytopenic purpura. N Engl J Med 2002;346:9951008.Google Scholar
Provan, D, Stasi, R, Newland, AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115:168–86.Google Scholar
Surveillance, Epidemiology, and End Results Program (SEER) Stat Fact Sheet: Myeloma. National Cancer Institute. Available at: http://seer.cancer.gov/statfacts/html/mulmy.html (accessed June 30, 2014).Google Scholar
DeSantis, CE, Lin, CC, Mariotto, AB, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014;64:252–71.Google Scholar
Kyle, RA, Gertz, MA, Witzig, TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003;78:2133.CrossRefGoogle ScholarPubMed
Katzmann, JA, Clark, RJ, Abraham, RS, et al. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains. Clin Chem 2002;48:1437–44.Google Scholar
Kyle, RA, Therneau, TM, Rajkumar, SV, et al. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med 2006;354:1362–9.Google Scholar
Rajkumar, SV, Kyle, RA, Therneau, TM, et al. Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance. Blood 2005;106:812–17.Google Scholar
Richardson, PG, Weller, E, Lonial, S, et al. Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myeloma. Blood 2010;116:679–86.Google Scholar
Cancer Facts and Figures. American Cancer Society. Available at: www.cancer.org/research/cancerfactsstatistics/allcancerfactsfigures/index (accessed July 30, 2014).Google Scholar
Rai, KR, Sawitsky, A, Cronkite, EP, et al. Clinical staging of chronic lymphocytic leukemia. Blood 1975;46:219–34.Google Scholar
Surveillance, Epidemiology, and End Results Program (SEER) Fast Stats 2014. National Cancer Institute. Available at: http://seer.cancer.gov/faststats/selections.php (accessed July 30, 2014).Google Scholar
Mauro, FR, Foa, R, Cerretti, R, et al. Autoimmune hemolytic anemia in chronic lymphocytic leukemia: clinical, therapeutic, and prognostic features. Blood 2000;95:2786–92.Google Scholar
Diehl, LF, Ketchum, LH. Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia. Semin Oncol 1998;25:8097.Google Scholar
Byrd, JC, Furman, RR, Coutre, SE, et al. Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia. N Engl J Med 2013;369:3242.Google Scholar
Surveillance, Epidemiology, and End Results Program (SEER) Cancer Statistics Reviews (CSR) 1975–2011. National Cancer Institute. Available at: http://seer.cancer.gov/csr/1975_2011 (accessed July 30, 2014).Google Scholar
Sorror, ML, Sandmaier, BM, Storer, BE, et al. Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies. JAMA 2011;306:1874–83.Google Scholar
Ania, BJ, Suman, VJ, Sobell, JL, et al. Trends in the incidence of polycythemia vera among Olmsted County, Minnesota residents, 1935–1989. Am J Hematol 1994;47:8993.Google Scholar
Baxter, EJ, Scott, LM, Campbell, PJ, et al. Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. Lancet 2005;365:1054–61.Google Scholar
Marchioli, R, Finazzi, G, Specchia, G, et al. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med 2013;368:2233.Google Scholar
Landolfi, R, Marchioli, R, Kutti, J, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med 2004;350:114–24.Google Scholar
Passamonti, F. How I treat polycythemia vera. Blood 2012;120:275–84.Google Scholar
Mesa, RA, Silverstein, MN, Jacobsen, SJ, et al. Population-based incidence and survival figures in essential thrombocythemia and agnogenic myeloid metaplasia: an Olmsted County Study, 1976–1995. Am J Hematol 1999;61:1015.Google Scholar
Beer, PA, Erber, WN, Campbell, PJ, Green, AR. How I treat essential thrombocythemia. Blood 2011;117:1472–82.Google Scholar
Cortelazzo, S, Finazzi, G, Ruggeri, M, et al. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med 1995;332:1132–6.Google Scholar
Harrison, CN, Campbell, PJ, Buck, G, et al. Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med 2005;353:3345.Google Scholar
Gisslinger, H, Gotic, M, Holowiecki, J, et al. Anagrelide compared with hydroxyurea in WHO-classified essential thrombocythemia: the ANAHYDRET Study, a randomized controlled trial. Blood 2013;121:1720–8.Google Scholar
Harrison, C, Kiladjian, JJ, Al-Ali, HK, et al. JAK inhibition with ruxolitinib versus best available therapy for myelofibrosis. N Engl J Med 2012;366:787–98.Google Scholar
Verstovsek, S, Mesa, RA, Gotlib, J, et al. A double-blind, placebo-controlled trial of ruxolitinib for myelofibrosis. N Engl J Med 2012;366:799807.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×