Anaemia: pernicious anaemia occurred in 2% of selected elderly patients.

Clinical bottom line (level 2c)

There was evidence for cobalamin deficiency or blocks to absorption in 2% of patients older than 60.
Around a quarter of these patients had mild anaemia or neurologic abnormalities.

Carmel: Archives of Internal Medicine 1996; 156: 1097-1100

Expires June 2003

The study

Outcome study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: community and medical outpatient clinic, USA. Patients recruited at adult education centre, social club and apartments complex for free-living elderly.

729 patients (aged 46% aged between 70 and 79 years, 59% male) volunteers

Excluded if

<60 years old
previously diagnosed with pernicious anaemia

pernicious anaemia diagnosed if any of: abnormal Schilling test (not defined), or low serum cobalamin and positive anti-intrinsic factor antibody (and/or abnormal methylmalonic acid or homocysteine levels)

All patients had serum cobalamin assay and anti-intrinsic factor antibody. If either positive, the patient was invited for follow-up for:
- blood count
- fasting serum gastrin level
- Schilling test

The evidence

outcome	time to outcome	number of patients/total number	% (95% CI)
pernicious anaemia	?	14/729	1.9% (0.92% to 2.9%)

Comments

Doubtful reference standard- only four patients (29%: 95% CI: 2.5% to 55%) had mild anaemia or neurologic abnormalities on follow-up. What would be the long-term consequences if these patients were not treated?
Uncertain as to whether this was a representative population, since patients volunteered.

Citation

Carmel R, : Prevalence of undiagnosed pernicious anemia in the elderly. Archives of Internal Medicine 1996; 156: 1097-1100

_{Clinical Question.}

_Patient	_volunteers
_{Intervention or Exposure}	_prevalence
_Outcome	_{pernicious anaemia}