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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 Aug; 66(8):925-32.JG

Abstract

BACKGROUND

To accurately determine the causes of anemia and proportion of unexplained anemia in a racially diverse cohort of older adults after a comprehensive and standardized evaluation.

METHODS

We evaluated results from a single-institutional university anemia clinic. Patients with anemia, defined as a hemoglobin less than 13.0 g/dL for men and less than 12.0 g/dL for women, underwent a prospective standardized history, physical examination, and laboratory measures, with additional studies including bone marrow examination as indicated. Empiric treatment trials were given for identified deficiencies.

RESULTS

One hundred and seventy-four primarily community-dwelling adults aged 65 years and older were evaluable. African Americans accounted for 69% of patients and whites were 27%. Anemia etiologies included iron deficiency anemia at 25.3%, anemia of chronic inflammation at 9.8%, and hematologic malignancy in 7.5%. Unexplained anemia in the elderly accounted for 43.7% and predominated in both African Americans and whites. The prevalence of iron deficiency anemia and hematologic malignancies did not differ by race. Unexplained anemia in the elderly showed a consistent phenotype composed of a hypoproliferative mild-to-moderate anemia with suppressed serum erythropoietin. Specifically, erythropoietin levels showed no correlation with hemoglobin concentration in unexplained anemia in the elderly (r = -.15, p = .19) as opposed to iron deficiency anemia (r = -.63, p < .0001).

CONCLUSIONS

In summary, an intensive hematologic evaluation reveals a wide number of anemia etiologies among older adults, including 7.5% with hematologic malignancies; nevertheless, unexplained anemia in the elderly prevails as the most common category in whites and African Americans.

Authors+Show Affiliations

Section of Hematology/Oncology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60605, USA. aartz@medicine.bsd.uchicago.eduNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21659341

Citation

Artz, Andrew S., and Michael J. Thirman. "Unexplained Anemia Predominates Despite an Intensive Evaluation in a Racially Diverse Cohort of Older Adults From a Referral Anemia Clinic." The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, vol. 66, no. 8, 2011, pp. 925-32.
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):925-32.
Artz, A. S., & Thirman, M. J. (2011). Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 66(8), 925-32. https://doi.org/10.1093/gerona/glr090
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):925-32. PubMed PMID: 21659341.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic. AU - Artz,Andrew S, AU - Thirman,Michael J, Y1 - 2011/06/09/ PY - 2011/6/11/entrez PY - 2011/6/11/pubmed PY - 2011/9/29/medline SP - 925 EP - 32 JF - The journals of gerontology. Series A, Biological sciences and medical sciences JO - J Gerontol A Biol Sci Med Sci VL - 66 IS - 8 N2 - BACKGROUND: To accurately determine the causes of anemia and proportion of unexplained anemia in a racially diverse cohort of older adults after a comprehensive and standardized evaluation. METHODS: We evaluated results from a single-institutional university anemia clinic. Patients with anemia, defined as a hemoglobin less than 13.0 g/dL for men and less than 12.0 g/dL for women, underwent a prospective standardized history, physical examination, and laboratory measures, with additional studies including bone marrow examination as indicated. Empiric treatment trials were given for identified deficiencies. RESULTS: One hundred and seventy-four primarily community-dwelling adults aged 65 years and older were evaluable. African Americans accounted for 69% of patients and whites were 27%. Anemia etiologies included iron deficiency anemia at 25.3%, anemia of chronic inflammation at 9.8%, and hematologic malignancy in 7.5%. Unexplained anemia in the elderly accounted for 43.7% and predominated in both African Americans and whites. The prevalence of iron deficiency anemia and hematologic malignancies did not differ by race. Unexplained anemia in the elderly showed a consistent phenotype composed of a hypoproliferative mild-to-moderate anemia with suppressed serum erythropoietin. Specifically, erythropoietin levels showed no correlation with hemoglobin concentration in unexplained anemia in the elderly (r = -.15, p = .19) as opposed to iron deficiency anemia (r = -.63, p < .0001). CONCLUSIONS: In summary, an intensive hematologic evaluation reveals a wide number of anemia etiologies among older adults, including 7.5% with hematologic malignancies; nevertheless, unexplained anemia in the elderly prevails as the most common category in whites and African Americans. SN - 1758-535X UR - https://www.unboundmedicine.com/medline/citation/21659341/Unexplained_anemia_predominates_despite_an_intensive_evaluation_in_a_racially_diverse_cohort_of_older_adults_from_a_referral_anemia_clinic_ DB - PRIME DP - Unbound Medicine ER -