Yaşlı Hastalarda Anemi Etiyolojisinin Kesitsel Analizi

Year 2023, Volume: 45 Issue: 6, 844 - 852, 24.10.2023

Tuğçe Akman , Deniz Arıca , Buğra Hatipoğlu , Enes Arslanoğlu , Ebru Koca , Sema Karakuş , Şahika Zeynep Akı

https://doi.org/10.20515/otd.1328585

Cited By: 1

Abstract

Bu çalışmanın amacı yaşlı hastalarda aneminin etiyolojisini ve özelliklerini hematoloji bakış açısıyla değerlendirmek ve açıklanamayan anemi oranını belirlemektir. Ocak 2015-Ocak 2020 tarihleri arasında Ankara Başkent Üniversitesi Hastanesi Hematoloji Kliniğine başvuran 65 yaş üstü yaşlı hastaların tıbbi kayıtları retrospektif olarak incelendi. WHO kriterlerine göre anemi için kabul edilen eşik değer, kadınlarda Hb <12 g/dL, erkeklerde <13 g/dL idi. 3330 yaşlı hastada anemi prevalansı %18 idi. Kadınların anemi tanısı alan erkeklere oranı 1,5:1, yaş ortalaması 77,34±8,32 idi. Ortalama Hb değeri 9,79±1,75 g/dl idi ve yaş ilerledikçe anlamlı olarak azaldı (p<0,001). Hastaların %68,3’ünde polifarmasi mevcuttu. Aneminin etiyolojik dağılımı; 339 (%56,5) hastada beslenme anemisi, 127 (%21,1) hastada hematolojik malignite, 125 (%20,8) hastada kronik hastalık anemisi ve 58 (%9,7) hastada açıklanamayan anemi idi. Kemik iliği biyopsisi endikasyonu olan hastaların %72'sine prosedür uygulandı. Yaşlılarda anemi komorbidite, polifarmasi ve ileri tetkiklerdeki sorunlar nedeniyle zorlu bir konudur. Yaşlı hastalarda aneminin hematolojik olarak değerlendirilmesi açıklanamayan anemi oranını azaltacaktır. İnvaziv prosedürler için hasta seçimi, kırılgan yaşlı hastalarda bir risk-fayda oranına dayanmalıdır.

Keywords

Açıklanamayan anemi, polifarmasi, prevalans, yaşlı

A Cross Sectional Analysis of Etiology of Anemia Among Elderly Patients

Abstract

The aim of this study is to evaluate the etiology and features of anemia in elderly patients from the perspective of hematology and to determine the rate of unexplained anemia. The medical records of elderly patients over the age of 65 who applied to the Hematology Department of Ankara Baskent University Hospital between January 2015 and January 2020 were retrospectively analyzed. According to WHO criteria, the threshold value accepted for anemia was Hb <12 g/dL for women and <13 g/dL for men. The prevalence of anemia was 18% among 3330 elderly patients. The ratio of women to men diagnosed with anemia was 1.5:1, and the mean age was 77.34±8.32. The mean Hb value was 9.79±1.75 g/dl and decreased significantly with advancing age (p<0.001). Polypharmacy was present in 68.3% of the patients. The etiological distribution of anemia was nutritional anemia in 339 (56.5%), hematologic malignancy in 127 (21.1%), anemia of chronic disease in 125 (20.8%), and unexplained anemia in 58 (9.7%) patients. 72% of the patients with indications for bone marrow biopsy had the procedure. Anemia in the elderly is a challenging issue due to comorbidity, polypharmacy, and problems in further examination. Hematological evaluation of anemia in elderly patients will reduce the rate of unexplained anemia. Patient selection for invasive procedures should be based on a risk-benefit ratio in frail elderly patients.

Keywords

Unexplained anemia, elderly, polypharmacy, prevalence

References

• 1. Katsumi A, Abe A, Tamura S, Matsushita T. Anemia in older adults as a geriatric syndrome: A review. Geriatr Gerontol Int. 2021;21(7):549-554.
• 2. Woodman R, Ferrucci L, Guralnik J. Anemia in older adults. Curr Opin Hematol 2005; 12: 123–128.
• 3. Guralnik J, Ershler W, Artz A, et al. Unexplained anemia of aging: Etiology, health consequences, and diagnostic criteria. J Am Geriatr Soc. 2022;70(3):891-899.
• 4. Roy CN, Snyder PJ, Stephens-Shields AJ et al. Association of testosterone levels with anemia in older men: a controlled clinical trial. JAMA Intern Med 2017; 177: 480– 490.
• 5. Shander A, Javidroozi M, Ashton ME. Drug-induced anemia and other red cell disorders: a guide in the age of polypharmacy. Curr Clin Pharmacol. 2011;6(4):295-303.
• 6. Petrosyan I, Blaison G, Andrès E, Federici L. Anaemia in the elderly: an aetiologic profile of a prospective cohort of 95 hospitalised patients. Eur J Intern Med. 2012;23(6):524-528.
• 7. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 2004; 104(8): 2263- 2268.
• 8. Tettamanti M, Lucca U, Gandini F, et al. Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study. Haematologica. 2010;95(11):1849-1856.
• 9. Michalak SS, Rupa-Matysek J, Hus I, Gil L. Unexplained anemia in the elderly—a real life analysis of 981 patients. Arch Med Sci. 2020; 16(4): 834- 841.
• 10. 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(8): 925- 932.
• 11. Bach V, Schruckmayer G, Sam I, Kemmler G, Stauder R. Prevalence and possible causes of anemia in the elderly: a cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging. 2014;9: 1187-1196.
• 12. Migone De Amicis M, Poggiali E, Motta I, et al. Anemia in elderly hospitalized patients: prevalence and clinical impact. Intern Emerg Med. 2015;10(5):581-586.
• 13. Abrahamsen JF, Monsen AL, Landi F, Haugland C, Nilsen RM, Ranhoff AH. Readmission and mortality one year after acute hospitalization in older patients with explained and unexplained anemia - a prospective observational cohort study. BMC Geriatr. 2016;16:109.
• 14. Petrosyan I, Blaison G, Andrès E, Federici L. Anaemia in the elderly: an aetiologic profile of a prospective cohort of 95 hospitalised patients. Eur J Intern Med. 2012;23(6):524-528.
• 15. Schop A, Stouten K, Riedl JA, et al. The accuracy of mean corpuscular volume guided anaemia classification in primary care. Fam Pract. 2021;38(6):735-739.
• 16. Fertrin KY. Diagnosis and management of iron deficiency in chronic inflammatory conditions (CIC): is too little iron making your patient sick?. Hematology Am Soc Hematol Educ Program. 2020;2020(1):478-486.
• 17. Oberley MJ, Yang DT. Laboratory testing for cobalamin deficiency in megaloblastic anemia. Am J Hematol. 2013;88(6):522-526.
• 18. Rasool S, Abid S, Iqbal MP, Mehboobali N, Haider G, Jafri W. Relationship between vitamin B12, folate and homocysteine levels and H. pylori infection in patients with functional dyspepsia: a cross-section study. BMC Res Notes. 2012;5:206.
• 19. Coban E, Timuragaoglu A, Meriç M. Iron deficiency anemia in the elderly: prevalence and endoscopic evaluation of the gastrointestinal tract in outpatients. Acta Haematol 2003;110(1):25-8.
• 20. Choi CW, Lee J, Park KH, et al. Prevalence and characteristics of anemia in the elderly: cross-sectional study of three urban Korean population samples. Am J Hematol. 2004;77(1):26-30.
• 21. Smith DL. Anemia in the elderly. Am Fam Physician. 2000;62(7):1565-1572.
• 22. Andrès E, Serraj K, Federici L, Vogel T, Kaltenbach G. Anemia in elderly patients: new insight into an old disorder. Geriatr Gerontol Int. 2013;13(3):519-527.
• 23. Sharma D, Suri V, Pannu AK, et al. Patterns of geriatric anemia: A hospital-based observational study in North India. J Family Med Prim Care. 2019;8(3):976-980.
• 24. Cooper JK, Gardner C. Effect of aging on serum albumin. J Am Geriatr Soc 1989;37(11):1039–42.
• 25. Baumgartner RN, Koehler KM, Romero L, Garry PJ. Serum albumin is associated with skeletal muscle in elderly men and women. Am J Clin Nutr 1996;64(4):552–8
• 26. Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marín-Ciancas F, Malafarina V. Serum albumin and health in older people: Review and meta analysis. Maturitas. 2015;81(1):17-27.
• 27. Goodnough LT, Schrier SL. Evaluation and management of anemia in the elderly. Am J Hematol 2014;89(1):88-96.
• 28. Eurostat Statistics Explained, Population structure and ageing [Cited Feb 2022 ]. Available from: https://ec.europa.eu/eurostat/
• 29. Fireman Z, Kopelman Y, Sternberg A. Endoscopic evaluation of iron deficiency anemia and follow-up in patients older than age 50. J Clin Gastroenterol. 1998;26(1):7-10.
• 30. Prosnitz RG, Yao B, Farrell CL, Clough R, Brizel DM. Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer. Int J Radiat Oncol Biol Phys. 2005;61(4):1087-1095.
• 31. Kara O, Smith L, Tan SG, Soysal P. The clinical implications and importance of anemia in older women. Acta Clin Belg. 2022;77(3):558-564.
• 32. Röhrig G, Rücker Y, Becker I, Schulz RJ, Lenzen-Großimlinghaus R, Willschrei P, Gebauer S, Modreker M, Jäger M, Wirth R. Association of anemia with functional and nutritional status in the German multicenter study "GeriAnaemie2013". Z Gerontol Geriatr 2017;50(6):532-537.