Pathy's Principles and Practice of Geriatric Medicine. Группа авторов

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Pathy's Principles and Practice of Geriatric Medicine - Группа авторов

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Disorders

       Angela M. Sanford

      Division of Geriatrics, Saint Louis University School of Medicine, St Louis, Missouri, USA

      In 1968, the World Health Organization (WHO) formally established the definition of anaemia. It was categorized as a haemoglobin level less than 13 g/dL in men and less than 12 g/dL in women.1 The normal haemoglobin range is adjusted for children, pregnancy, gender, smokers, and those who live at higher altitudes, but there have yet to be any large studies specifically focused on normal haemoglobin values in older people. Additionally, the original cohort used to establish the normal values of haemoglobin at the population level excluded elderly patients, and thus controversy exists regarding normal values for older people. A natural decline in haemoglobin levels in older adults is accepted, but at this time, it is not clear if this happens due to the ageing process, underlying chronic disease, or some other unknown cause. While the absolute value of haemoglobin is important when considering if someone is anaemic, it is also important to take into account the trend of haemoglobin in an individual and whether there has been a substantial change from previous values.

      Anaemia in older people is often underdiagnosed and undertreated despite being associated with increased morbidity and poor quality of life in older adults.2 Older people with anaemia have been found to have added impairments in activities of daily living and functional status,3 increased weakness and fatigue,4 and higher rates of frailty,5 cognitive decline,6 depression,3 and fractures.7 In addition, hospitalized older adults with anaemia have longer lengths of stay and increased readmission rates.8,9 While anaemia is very common in those with advanced age, it is not considered a normal aspect of ageing, and older adults with anaemia should undergo a workup to evaluate the cause of anaemia and establish a diagnosis. Once a diagnosis is established, a treatment plan can be implemented. Treatment of anaemia typically requires a multi‐faceted plan. Resolution may be difficult to achieve – particularly if the anaemia is due to underlying chronic inflammation and disease.

Schematic illustration of aetiology of anaemia.

      Iron deficiency anaemia

Schematic illustration of most prevalent types of anaemia in older adults. Schematic illustration of diagnostic laboratory values for iron deficiency anaemia, anaemia of chronic disease, and anaemia of chronic kidney disease.

      Iron is found in many varieties of food sources, with red meat containing the highest amounts, and is necessary for the synthesis of oxygen transport proteins found in haemoglobin and oxidation reductions necessary for cellular metabolism. It is consumed in the ferric formulation (Fe3+) and converted by the acidity of the stomach to the ferrous formulation (Fe2+). It is absorbed primarily in the duodenum, with lesser amounts absorbed in the jejunum through the iron transporter ferroportin, and is then bound to the protein transferrin, which acts as its carrier in the blood.17 If not needed in muscle or for immediate use in red blood cell production, iron is stored bound to the protein ferritin in the liver. Because we consume only

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