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Anemia in the older adult

Elizabeth A Price, MD
Stanley L Schrier, MD
Section Editors
William C Mentzer, MD
Kenneth E Schmader, MD
Deputy Editor
Jennifer S Tirnauer, MD


Anemia is common in the older adult population. Although typically mild, it has been associated with substantial morbidity and mortality.

Anemia in the older adult will be discussed here [1-5]. The overall approach to the anemic adult patient is discussed separately. (See "Approach to the adult patient with anemia".)


WHO criteria for anemia — Although average hemoglobin values differ from laboratory to laboratory, a working definition of anemia in the adult is a level less than the normal mean minus two standard deviations. For the values shown in the table this would be a hemoglobin <14.0 g/dL (<140 g/L) in men and <12.3 g/dL (<123 g/L) in women (table 1).

Alternatively, the 1968 World Health Organization (WHO) criteria of a hemoglobin (Hgb) <13 g/dL (<130 g/L) in men and <12 g/dL (<120 g/L) in women have been used to define anemia [6]. However, these criteria were based upon data in populations that did not include individuals >65 years of age [7-10], and may or may not be applicable to the older individual [11,12]. (See "Approach to the adult patient with anemia", section on 'Normal ranges for hemoglobin/HCT'.)

Racial and ethnic considerations — There is debate as to whether modifications in the definition of anemia should be made for different racial and ethnic groups. As an example, up to 30 percent of African-Americans carry the 3.7 kb deletion in the alpha thalassemia gene. In the heterozygous state (ie, silent carrier of alpha thalassemia, thalassemia minima) this leads to low-normal and occasionally mildly low hemoglobin and mean corpuscular volume values, whereas homozygotes (ie, alpha thalassemia trait) have a mild, microcytic anemia [13]. Thus, the presence of thalassemia may contribute to lowering of the average hemoglobin level in racial or ethnic groups having a high incidence of these mutations. (See "Clinical manifestations and diagnosis of the thalassemias".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 11, 2017.
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