GeriQBank · Paper III · Q8
Anaemia in the Elderly & Evaluation of Anaemia
- Chapter
- Haematology
- Years asked
- Not recorded in the source
- Frequency
- No university frequency data for this paper yet
Detailed answer
Pro · free in betaAttempt it firstOutline your answer before revealing it — definition, causes, evaluation, management and the geriatric angle.Reveal answer
Well covered: Pathy's Ch. 22 (Figures 22.1, 22.3, 22.4) — largely textbook-derived.
High-Yield Points
Definition: Hb <13 g/dL men, <12 g/dL women — but also track the trend from the patient's own baseline.
Anaemia is NOT normal ageing — signifies disease; associated with mortality, disability, hospitalisation.
Prevalence: 10–25% over 65, up to 50% over 80 and in nursing homes.
Causes (Bach et al., quoted in Pathy's): ACD 62.1%, CKD anaemia 11.3–45.1%, multifactorial 28.1%, iron deficiency 14.4%, clonal disorders 10%, folate 6.7%, B12 2%.
Associated with impaired ADLs, frailty, cognitive decline, depression, fractures; higher RDW independently predicts mortality.
MCV unreliable in the elderly — B12 deficiency may be normocytic; concurrent diseases can cancel each other's MCV effect.
Presentation often a geriatric syndrome — falls, delirium, syncope — not a haematological complaint.
Stepwise Evaluation
Step Action
1 History: bleeding, diet, alcohol, drugs (PPIs/H2 blockers, metformin, NSAIDs)
2 Examination: pallor, jaundice, glossitis, koilonychia, splenomegaly, neuro exam for SACD 3 CBC + indices + reticulocyte count + blood film (single most informative test) 4 Reticulocytes LOW → hypoproliferative; HIGH → haemolysis/blood loss 5 Iron studies: ferritin <30 → IDA; >100 → ACD; 30–100 → add sTfR 6 B12/folate: B12 <200 pg/mL deficient; 200–350 equivocal → add MMA + homocysteine 7 Renal/liver/thyroid function, CRP/ESR 8 GI evaluation mandatory for IDA in an older adult — endoscopy top and bottom 9 Marrow biopsy if macrocytic + other cytopenias + low reticulocytes (clonal disorder red flags)
Treatment by Cause
Cause Treatment
Iron deficiency Oral iron once daily; IV if malabsorptive/intolerant; continue 3–6 months after correction B12 deficiency Oral 2000 mcg daily as effective as IM; IM 1000 mcg weekly then monthly if severe Folate deficiency Folic acid 1 mg daily ACD Treat underlying disease; iron only if concomitant deficiency Latest Updates (2023–Present)
WHO 2024 reaffirmed Hb cutoffs; adjust for altitude/smoking, NOT inflammation or ethnicity; no separate elderly-specific cutoff yet. Oral iron dosing changed: alternate-day, single-morning dosing (60–120mg elemental iron) increases fractional absorption ~33% with fewer GI side effects — now recommended by ACG and EHA (2024). AABB 2023: restrictive transfusion threshold Hb<7 g/dL generally (<7.5 cardiac surgery, <8 orthopaedic/CVD) — but MINT trial (2023) in acute MI showed higher 6-month cardiac mortality with restrictive strategy; 2025 AABB now suggests liberal threshold <10 g/dL in acute MI. "Unexplained anaemia of the elderly" increasingly reclassified as CCUS/clonal haematopoiesis on molecular testing.
Current Practice Update
Domain Pathy's (2022) Current evidence
Oral iron dosing Once daily only, never divided Alternate-day single morning dose now preferred MD Geriatrics – Haematology Compendium Page 17 of 34 Transfusion Not discussed in detail Restrictive generally; LIBERAL (<10g/dL) in acute MI Unexplained anaemia Recognised as a category Increasingly reclassified as CCUS/clonal haematopoiesis MD Geriatrics – Haematology Compendium Page 18 of 34
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References
- PAPERS-2-3-4_COMBINED.pdf — page 856
- GeriQBank source PDF — p. 856
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