Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-17T18:15:52.226Z Has data issue: false hasContentIssue false

Chapter 40 - Anemia and Other Hematological Problems

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

By
Satish Shanbhag  and
Rakhi P. Naik
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Hematologic abnormalities occur commonly in the elderly. The prevalence of anemia appears to increase with age and may be caused by various underlying etiologies, including iron deficiency, anemia of inflammation, or myelodysplastic syndrome. Thrombocytopenia due to underlying comorbidities, medications, or immune thrombocytopenia (ITP) may also occur. Hematologic malignancies such as chronic lymphocytic leukemia (CLL) and multiple myeloma also become more prevalent with age. A systematic approach to the evaluation of these hematologic abnormalities is imperative to help guide diagnosis and management. For acute or progressive conditions, a multidisciplinary team of both geriatricians and hematologists is essential to ensure proper diagnosis, frailty assessment, and initiation of appropriate therapies. Novel therapies for the various hematological malignancies are well tolerated, turning life-threatening illnesses into chronic disease that can be managed while preserving quality of life.

Keywords

anemiamicrocyticmacrocytichemolysisiron deficiencythrombocytopeniamyelodysplastic syndromehematologic malignancymyelomaleukemia
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 493 - 505
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blanc, B, Finch, C, Hallberg, L, et al. Nutritional anaemia: Report of a WHO scientific group. WHO Tech Report Series. 1968; 405:5–37.Google Scholar
Zakai, NA, Katz, R, Hirsch, C, et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: The Cardiovascular Health Study. Arch Intern Med. 2005; 165:2214–2220.Google Scholar
Guralnik, JM, Eisenstaedt, RS, Ferrucci, L, Klein, HG, Woodman, RC. Prevalence of anemia in persons 65 years and older in the United States: Evidence for a high rate of unexplained anemia. Blood. 2004; 104:2263–2268.Google Scholar
Izaks, GJ, Westendorp, RG, Knook, DL. The definition of anemia in older persons. JAMA. 1999; 281:1714–1717.Google Scholar
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; 66:925–932.CrossRefGoogle Scholar
Ferrucci, L, Semba, RD, Guralnik, JM, et al. Proinflammatory state, hepcidin, and anemia in older persons. Blood. 2010; 115:3810–3816.CrossRefGoogle ScholarPubMed
Adler, AS, Kawahara, TL, Segal, E, Chang, HY. Reversal of aging by NFkappaB blockade. Cell Cycle. 2008; 7:556–559.CrossRefGoogle ScholarPubMed
Chambers, SM, Shaw, CA, Gatza, C, Fisk, CJ, Donehower, LA, Goodell, MA. Aging hematopoietic stem cells decline in function and exhibit epigenetic dysregulation. PLoS Biol. 2007; 5:e201.CrossRefGoogle ScholarPubMed
Chambers, SM, Goodell, MA. Hematopoietic stem cell aging: Wrinkles in stem cell potential. Stem Cell Rev. 2007; 3:201–211.Google Scholar
Culleton, BF, Manns, BJ, Zhang, J, Tonelli, M, Klarenbach, S, Hemmelgarn, BR. Impact of anemia on hospitalization and mortality in older adults. Blood. 2006; 107:3841–3846.Google Scholar
Zakai, NA, French, B, Arnold, AM, et al. Hemoglobin decline, function, and mortality in the elderly: The cardiovascular health study. Am J Hematol. 2013; 88:5–9.CrossRefGoogle ScholarPubMed
Dong, X, Mendes de Leon, C, Artz, A, Tang, Y, Shah, R, Evans, D. A population-based study of hemoglobin, race, and mortality in elderly persons. J Gerontol A Biol Sci Med Sci. 2008; 63:873–878.Google Scholar
Denny, SD, Kuchibhatla, MN, Cohen, HJ. Impact of anemia on mortality, cognition, and function in community-dwelling elderly. Am J Med. 2006; 119:327–334.CrossRefGoogle ScholarPubMed
Penninx, BW, Guralnik, JM, Onder, G, Ferrucci, L, Wallace, RB, Pahor, M. Anemia and decline in physical performance among older persons. Am J Med. 2003; 115:104–110.CrossRefGoogle ScholarPubMed
Penninx, BW, Pluijm, SM, Lips, P, et al. Late-life anemia is associated with increased risk of recurrent falls. J Am Geriatr Soc. 2005; 53:2106–2111.CrossRefGoogle ScholarPubMed
Chaves, PH, Semba, RD, Leng, SX, et al. Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: The Women’s Health and Aging Studies I and II. J Gerontol A Biol Sci Med Sci. 2005; 60:729–735.Google Scholar
Deal, JA, Carlson, MC, Xue, QL, Fried, LP, Chaves, PH. Anemia and 9-year domain-specific cognitive decline in community-dwelling older women: The Women’s Health and Aging Study II. J Am Geriatr Soc. 2009; 57:1604–1611.CrossRefGoogle ScholarPubMed
Zilinski, J, Zillmann, R, Becker, I, Benzing, T, Schulz, RJ, Roehrig, G. Prevalence of anemia among elderly inpatients and its association with multidimensional loss of function. Ann Hematol. 2014; 93(10):1645–1654.Google Scholar
Hong, CH, Falvey, C, Harris, TB, et al. Anemia and risk of dementia in older adults: findings from the Health ABC study. Neurology. 2013; 81:528–533.Google Scholar
Joosten, E, Ghesquiere, B, Linthoudt, H, et al. Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient. Am J Med. 1999; 107:24–29.Google Scholar
Pang, WW, Schrier, SL. Anemia in the elderly. Curr Opin Hematol. 2012; 19:133–140.Google Scholar
Cook, JD, Flowers, CH, Skikne, BS. The quantitative assessment of body iron. Blood. 2003; 101:3359–3364.Google Scholar
Keel, SB, Abkowitz, JL. The microcytic red cell and the anemia of inflammation. N Engl J Med. 2009; 361:1904–1906.Google Scholar
Rector, WG Jr. Pica: Its frequency and significance in patients with iron-deficiency anemia due to chronic gastrointestinal blood loss. J Gen Intern Med. 1989; 4:512–513.Google Scholar
Moist, LM, Troyanov, S, White, CT, et al. Canadian Society of Nephrology commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. Am J Kidney Dis. 2013; 62:860–873.CrossRefGoogle ScholarPubMed
Martin, A, Thompson, AA. Thalassemias. Pediatr Clin North Am. 2013; 60:1383–1391.CrossRefGoogle ScholarPubMed
Muncie, HL Jr, Campbell, J. Alpha and beta thalassemia. Am Fam Physician. 2009; 80:339–344.Google Scholar
Price, EA, Mehra, R, Holmes, TH, Schrier, SL. Anemia in older persons: Etiology and evaluation. Blood Cells Mol Dis. 2011; 46:159–165.Google Scholar
Corazza, F, Beguin, Y, Bergmann, P, et al. Anemia in children with cancer is associated with decreased erythropoietic activity and not with inadequate erythropoietin production. Blood. 1998; 92:1793–1798.Google Scholar
Weiss, G, Goodnough, LT. Anemia of chronic disease. N Engl J Med. 2005; 352:1011–1023.CrossRefGoogle ScholarPubMed
Artz, AS, Xue, QL, Wickrema, A, et al. Unexplained anaemia in the elderly is characterised by features of low grade inflammation. Br J Haematol. 2014; 167(2):286–269.Google Scholar
Allen, LA, Felker, GM, Mehra, MR, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail. 2010; 16:230–238.Google Scholar
Roy, CN. Anemia of inflammation. Hematology Am Soc Hematol Educ Program. 2010; 2010:276–280.Google Scholar
Merchant, AA, Roy, CN. Not so benign haematology: Anaemia of the elderly. Br J Haematol. 2012; 156:173–185.Google Scholar
Goodnough, LT, Levy, JH, Murphy, MF. Concepts of blood transfusion in adults. Lancet. 2013; 381:1845–1854.Google Scholar
Finch, CA, Lenfant, C. Oxygen transport in man. N Engl J Med. 1972; 286:407–415.Google Scholar
Kazmi, WH, Kausz, AT, Khan, S, et al. Anemia: An early complication of chronic renal insufficiency. Am J Kidney Dis. 2001; 38:803–812.Google Scholar
Erslev, AJ. Erythropoietin. N Engl J Med. 1991; 324:1339–1344.Google Scholar
Donnelly, S, Shah, BR. Erythropoietin deficiency in hyporeninemia. Am J Kidney Dis. 1999; 33:947–953.CrossRefGoogle ScholarPubMed
Ma, JZ, Ebben, J, Xia, H, Collins, AJ. Hematocrit level and associated mortality in hemodialysis patients. J Am Soc Nephrol. 1999; 10:610–619.CrossRefGoogle ScholarPubMed
Fernandez-Rodriguez, AM, Guindeo-Casasus, MC, Molero-Labarta, T, et al. Diagnosis of iron deficiency in chronic renal failure. Am J Kidney Dis. 1999; 34:508–513.Google Scholar
Phrommintikul, A, Haas, SJ, Elsik, M, Krum, H. Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: A meta-analysis. Lancet. 2007; 369:381–388.Google Scholar
Andres, E, Loukili, NH, Noel, E, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004; 171:251–259.CrossRefGoogle ScholarPubMed
Carmel, R. How I treat cobalamin (vitamin B12) deficiency. Blood. 2008; 112:2214–2221.Google Scholar
Nimo, RE, Carmel, R. Increased sensitivity of detection of the blocking (type I) anti-intrinsic factor antibody. Am J Clin Pathol. 1987; 88:729–733.Google Scholar
Eussen, SJ, de Groot, LC, Clarke, R, et al. Oral cyanocobalamin supplementation in older people with vitamin B12 deficiency: A dose-finding trial. Arch Intern Med. 2005; 165:1167–1172.Google Scholar
Ades, L, Itzykson, R, Fenaux, P. Myelodysplastic syndromes. Lancet. 2014; 383:2239–2252.Google Scholar
Will, B, Zhou, L, Vogler, TO, et al. Stem and progenitor cells in myelodysplastic syndromes show aberrant stage-specific expansion and harbor genetic and epigenetic alterations. Blood. 2012; 120:2076–2086.Google Scholar
Anttila, P, Ihalainen, J, Salo, A, Heiskanen, M, Juvonen, E, Palotie, A. Idiopathic macrocytic anaemia in the aged: molecular and cytogenetic findings. Br J Haematol. 1995; 90:797–803.Google Scholar
Greenberg, PL, Tuechler, H, Schanz, J, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012; 120:2454–2465.Google Scholar
Zeidan, AM, Linhares, Y, Gore, SD. Current therapy of myelodysplastic syndromes. Blood Rev. 2013; 27:243–259.Google Scholar
Gehrs, BC, Friedberg, RC. Autoimmune hemolytic anemia. Am J Hematol. 2002; 69:258–271.Google Scholar
Crisp, D, Pruzanski, W. B-cell neoplasms with homogeneous cold-reacting antibodies (cold agglutinins). Am J Med. 1982; 72:915–922.Google Scholar
Berentsen, S. Cold agglutinin-mediated autoimmune hemolytic anemia in Waldenstrom’s macroglobulinemia. Clin Lymphoma Myeloma. 2009; 9:110–112.Google Scholar
Berentsen, S, Ulvestad, E, Langholm, R, et al. Primary chronic cold agglutinin disease: A population based clinical study of 86 patients. Haematologica. 2006; 91:460–466.Google Scholar
Smyth, SS, McEver, RP, Weyrich, AS, et al. Platelet functions beyond hemostasis. J Thromb Haemost. 2009; 7:1759–1766.Google Scholar
Williamson, DR, Albert, M, Heels-Ansdell, D, et al. Thrombocytopenia in critically ill patients receiving thromboprophylaxis: frequency, risk factors, and outcomes. Chest. 2013; 144:1207–1215.CrossRefGoogle ScholarPubMed
Mendes, FD, Suzuki, A, Sanderson, SO, Lindor, KD, Angulo, P. Prevalence and indicators of portal hypertension in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2012; 10:1028,33.e2.Google Scholar
Sheikh, MY, Raoufi, R, Atla, PR, Riaz, M, Oberer, C, Moffett, MJ. Prevalence of cirrhosis in patients with thrombocytopenia who receive bone marrow biopsy. Saudi J Gastroenterol. 2012; 18:257–262.Google Scholar
Aster, RH. Pooling of platelets in the spleen: Role in the pathogenesis of “hypersplenic” thrombocytopenia. J Clin Invest. 1966; 45:645–657.Google Scholar
Peck-Radosavljevic, M, Zacherl, J, Meng, YG, et al. Is inadequate thrombopoietin production a major cause of thrombocytopenia in cirrhosis of the liver? J Hepatol. 1997; 27:127–131.Google Scholar
Kuwana, M, Okazaki, Y, Ikeda, Y. Splenic macrophages maintain the anti-platelet autoimmune response via uptake of opsonized platelets in patients with immune thrombocytopenic purpura. J Thromb Haemost. 2009; 7:322–329.Google Scholar
Frederiksen, H, Schmidt, K. The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood. 1999; 94:909–913.Google Scholar
Neunert, C, Lim, W, Crowther, M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011; 117:4190–4207.Google Scholar
Cines, DB, Blanchette, VS. Immune thrombocytopenic purpura. N Engl J Med. 2002; 346:995–1008.Google Scholar
Provan, D, Stasi, R, Newland, AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115:168–186.Google Scholar
Surveillance, Epidemiology, and End Results Program (SEER) Stat Fact Sheet: Myeloma. National Cancer Institute. http://seer.cancer.gov/statfacts/html/mulmy.html. Accessed on 01/14/2014.Google Scholar
DeSantis, CE, Lin, CC, Mariotto, AB, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014; 64:252–271.Google Scholar
Kyle, RA, Gertz, MA, Witzig, TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003; 78:21–33.Google Scholar
Katzmann, JA, Clark, RJ, Abraham, RS, et al. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: Relative sensitivity for detection of monoclonal light chains. Clin Chem. 2002; 48:1437–1444.Google Scholar
Kyle, RA, Therneau, TM, Rajkumar, SV, et al. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med. 2006; 354:1362–1369.CrossRefGoogle ScholarPubMed
Rajkumar, SV, Kyle, RA, Therneau, TM, et al. Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance. Blood. 2005; 106:812–817.Google Scholar
Rajkumar, SV, Dimopoulos, MA, Palumbo, A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet. 2014: 15; e538–e548.Google Scholar
Richardson, PG, Weller, E, Lonial, S, et al. Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myeloma. Blood. 2010; 116:679–686.Google Scholar
Cancer Facts and Figures. American Cancer Society. www.cancer.org/research/cancerfactsstatistics/allcancerfactsfigures/index. Accessed on 07/30/2014.Google Scholar
Rai, KR, Sawitsky, A, Cronkite, EP, Chanana, AD, Levy, RN, Pasternack, BS. Clinical staging of chronic lymphocytic leukemia. Blood. 1975; 46:219–234.Google Scholar
Bailey, C, Richardson, LC, Allemani, C, et al. Adult leukemia survival trends in the United States by subtype: A population-based registry study of 370,994 patients diagnosed during 1995–2009. Cancer. 2018; 124:3856–3867.Google Scholar
Surveillance, Epidemiology, and End Results Program (SEER) Fast Stats 2014. National Cancer Institute. http://seer.cancer.gov/faststats/selections.php. Accessed on 07/30/2014.Google Scholar
Mauro, FR, Foa, R, Cerretti, R, et al. Autoimmune hemolytic anemia in chronic lymphocytic leukemia: Clinical, therapeutic, and prognostic features. Blood. 2000; 95:2786–2792.Google Scholar
Diehl, LF, Ketchum, LH. Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia. Semin Oncol. 1998; 25:80–97.Google Scholar
Delgado, J, Nadeu, F, Colomer, D, Campo, E. Chronic lymphocytic leukemia: from molecular pathogenesis to novel therapeutic strategies. Haematologica. 2020; 105:236000.Google Scholar
Deininger, MW, Shah, NP, Altman, JK, et al. Chronic Myeloid Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2020; 18:1385–1415.Google Scholar
Surveillance, Epidemiology, and End Results Program (SEER) Cancer Statistics Reviews (CSR) 1975–2011. National Cancer Institute. http://seer.cancer.gov/csr/1975_2011. Accessed on 07/30/2014.Google Scholar
Sorror, ML, Sandmaier, BM, Storer, BE, et al. Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies. JAMA. 2011; 306:1874–1883.Google Scholar
Ania, BJ, Suman, VJ, Sobell, JL, Codd, MB, Silverstein, MN, Melton, LJ 3rd. Trends in the incidence of polycythemia vera among Olmsted County, Minnesota residents, 1935–1989. Am J Hematol. 1994; 47:89–93.Google Scholar
Baxter, EJ, Scott, LM, Campbell, PJ, et al. Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. Lancet. 2005; 365:1054–1061.Google Scholar
Marchioli, R, Finazzi, G, Specchia, G, et al. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med. 2013; 368:22–33.Google Scholar
Landolfi, R, Marchioli, R, Kutti, J, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med. 2004; 350:114–124.Google Scholar
Passamonti, F. How I treat polycythemia vera. Blood. 2012; 120:275–284.Google Scholar
Mesa, RA, Silverstein, MN, Jacobsen, SJ, Wollan, PC, Tefferi, A. Population-based incidence and survival figures in essential thrombocythemia and agnogenic myeloid metaplasia: An Olmsted County Study, 1976–1995. Am J Hematol. 1999; 61:10–15.Google Scholar
Beer, PA, Erber, WN, Campbell, PJ, Green, AR. How I treat essential thrombocythemia. Blood. 2011; 117:1472–1482.CrossRefGoogle Scholar
Cortelazzo, S, Finazzi, G, Ruggeri, M, et al. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med. 1995; 332:1132–1136.Google Scholar
Harrison, CN, Campbell, PJ, Buck, G, et al. Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med. 2005; 353:33–45.Google Scholar
Gisslinger, H, Gotic, M, Holowiecki, J, et al. Anagrelide compared with hydroxyurea in WHO-classified essential thrombocythemia: The ANAHYDRET Study, a randomized controlled trial. Blood. 2013; 121:1720–1728.Google Scholar
Harrison, C, Kiladjian, JJ, Al-Ali, HK, et al. JAK inhibition with ruxolitinib versus best available therapy for myelofibrosis. N Engl J Med. 2012; 366:787–798.Google Scholar
Verstovsek, S, Mesa, RA, Gotlib, J, et al. A double-blind, placebo-controlled trial of ruxolitinib for myelofibrosis. N Engl J Med. 2012; 366:799–807.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×