Anaemia: was common in the elderly.

Clinical bottom line (level 2c)

  1. A quarter of elderly patients admitted to an acute geriatric ward had anaemia.
  2. The commonest causes were anaemia of chronic disease, iron-deficiency anaemia and acute bleeding.
Joosten et al: Gerontology 1992; 38: 111-117
Expires September 2003

The study

Setting: acute geriatric ward, university ward, Belgium

732 patients (aged range 65 to 98 years; median 81, 61% female) admitted to an acute geriatric ward.

  • All patients had:
    • creatinine, alkaline phosphatase, AST, ALT, LDH
    • serum iron and iron-binding capacity
    • folate, vitamin B12
    • ferritin
    • direct Coombs's test and haptoglobin
  • Further tests (eg. endoscopy, radiography, Schilling) were ordered as necessary.

The evidence


differential diagnosis number of patients prevalence
(95% CI)
anaemia 178 24%
(21% to 27%)
anaemia of chronic disease 61 34%
(27% to 41%)
iron-deficiency anaemia 27 15%
(9.9% to 20%)
post-haemorrhagic anaemia 13 7.3%
(3.5% to 11%)
myelodysplastic syndrome and acute leukaemia 10 5.6%
(2.2% to 9.0%)
vitamin B12/folate deficiency 10 5.6%
(2.2% to 9.0%)
chronic leukaemia, lymphoma-related disorders 9 5.1%
(1.8% to 8.3%)
other haematological disorders (myelofibrosis, aplastic anaemia, haemolytic anaemia) 5 2.8%
(0.4% to 5.2%)
no cause found 31 17%
(12% to 23%)

  • anaemia diagnosed if haemoglobin <11.5 g/dl on a single venous sample within 48 hours of admission
  • anaemia of chronic disease- iron <13 µ mol/l, iron-binding capacity <54 µ mol/l, transferrin saturation <25%. MCV <98 fl and ferritin >100 µ g/l
  • iron-deficiency anaemia- ferritin <20 µ g/l or no iron detected on bone marrow aspirate stained with Prussian blue
  • vitamin B12 deficiency- cobalamin <110 pmol/l and at least one of:
    • abnormal Schilling test
    • megaloblastic bone marrow
    • significant therapeutic response upon replacement
  • folate deficiency- folate <225 nmol/l with a megaloblastic anaemia or a significant response to replacement

Citation

  1. Joosten E, Pelemans W, Hiele M, et al: Prevalence and causes of anaemia in a geriatric hospitalized population. Gerontology 1992; 38: 111-117
Contributor: Chris Ball and Clare Wotton, June 2000
Reviewer: Daniel Sontheimer

Clinical Question.
Patient admitted to acute geriatric ward
Intervention or Exposure prevalence
Outcome anaemia