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Anemia at older age: etiologies, clinical implications and management

Reinhard Stauder, Peter Valent and Igor Theurl

Abstract

Anemia is quite frequently diagnosed in older individuals and is a key indicator of various reactive and clonal conditions. Many underlying diseases, like the myelodysplastic syndromes (MDS), develop preferentially in elderly individuals. The prevalence of anemia at older age is increasing, and this is mainly due to more frequently applied diagnostics and demographic changes in our societies. The etiology of anemia at older age is complex and ranges from bone marrow failure syndromes to chronic kidney disease, and from nutritional deficiencies to inflammatory processes including inflammaging in immunosenescence. In a smaller number of cases, no clear-cut etiology is identified. These patients are referred to as unexplained anemia (UA) or idiopathic cytopenia of unknown significance (ICUS). In others, somatic mutations in leukocytes are found but diagnostic criteria for MDS or other hematological diseases are not fulfilled, a condition termed clonal cytopenia of uncertain significance (CCUS). Management of anemias at older age depends on i) the severity of the anemia, ii) underlying condition(s), and iii) patient-related factors, including comorbidities. Even a mild anemia may substantially affect physical and cognitive capacities and QoL. An underestimated aspect is that due to age-related changes, organ function such as erythropoietin production in the kidney may become suboptimal. Management and treatment of anemia in older patients often requires a multidisciplinary approach and detailed investigations of organ function. In this article, we review current concepts around anemias at older age, with special emphasis on etiologies, clinical implications and innovative concepts in the management of these patients.

  • Submitted July 6, 2017.
  • Accepted October 5, 2017.