Not so benign haematology: anaemia of the elderly

Abstract

Developed countries, such as the United Kingdom, are experiencing a change in demographics resulting in the largest proportion of adults over 65 years of age that our health systems have ever experienced. As such, haematologists must be prepared to evaluate and treat anaemia in a more complicated patient population, but sufficient evidence-based guidelines are lacking. Critical next steps that must be taken to ensure the best care of this population include the determination of appropriate haemoglobin concentrations for older adults in light of age, gender, race, and comorbidities; the development of interventional trials that address physical performance outcomes in addition to haemoglobin targets; and translational studies which address the molecular pathogenesis of anaemia in older adults with the most advanced scientific approaches.

Figure 1. Possible causes of anaemia in older adults

Erythroid prognitors differentiate from haematopoietic stem cells (HSCs) in the context of a complex microenvironment. Systemic effects of acute or sub-clinical inflammation, erythropoietin (Epo) production and micronutrient availability all have the potential to negatively impact erythroid maturation and haemoglobin production. Additionally, defects intrinsic to HSCs, such as telomere length, DNA integrity and epigenetic marks, have the potential to impair maturation along the erythroid lineage. RBC, red blood cell; ROS, reactive oxygen species; Hepc, hepcidin antimicrobial peptide.