Haematology in the elderly


Haematology in the elderly

Average life expectancy is increasing. Elderly people (>65 years) are likely to make up more than 20% of the world’s population by 2050. This effect is particularly marked in the developed world where in some countries the population over 65 years already outnumbers those below 20 years. An ageing population has implications for the practice of clinical haematology. There are significant age-related changes in haematopoiesis and haemostasis. Many blood diseases, especially malignant disorders, are more common in older people. The management of blood diseases in the elderly is often complicated by frailty, comorbidity and a need for extra care in the hospital and community.


Anaemia is a common clinical problem in the elderly. The prevalence rises rapidly after 50 years and approaches 20% in people aged over 80 years. In general, one third of cases will have an identifiable nutritional deficiency (iron, vitamin B12 or folate) (Fig 46.1). Where iron deficiency is the cause of anaemia it is often secondary to gastrointestinal blood loss, and underlying bowel pathology (e.g. colonic carcinoma) should be excluded. Another third of cases have the anaemia of chronic disease. These patients have an obvious chronic inflammatory condition (see p. 36) and will often have a measurable acute phase response (e.g. elevated C-reactive protein). In the final third of elderly patents, there is no clear cause for the anaemia (sometimes termed ‘anaemia unexplained’). This entity is a diagnosis of exclusion and has been the focus of much recent interest. A few cases may be explained by myelodysplastic syndrome or other rarer causes of anaemia but it is probably mainly due to a combination of age-related suppression of erythroid colony formation, insensitivity to erythropoietin and impaired iron utilisation.

Whatever its aetiology, anaemia in the elderly is a relevant finding. It is associated with reduced physical and cognitive functioning, an increased chance of falls, an aggravation of comorbidity such as cardiac and neurological disease, and reduced survival. A low haemoglobin level should not be readily dismissed as part of ‘normal ageing’.

Where the anaemia has an explained cause (e.g. iron deficiency), treatment is specific for that disorder. Erythropoeitin may be used in chronic renal failure. Blood transfusion is needed in only a minority of cases (e.g. for the symptomatic anaemia of myelodysplastic syndrome), and in the very elderly and frail must be undertaken cautiously to avoid fluid overload and the exacerbation of cardiac failure. The treatment of unexplained anaemia in the elderly remains controversial with no clear guidelines.

Jun 12, 2016 | Posted by in HEMATOLOGY | Comments Off on Haematology in the elderly
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