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Anemia in the older adult

INTRODUCTION

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".)

DEFINING ANEMIA IN THE OLDER ADULT

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 range'.)

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: Jun 2014. | This topic last updated: Jul 7, 2014.
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