Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Nov 28;13(11):e19971.
doi: 10.7759/cureus.19971. eCollection 2021 Nov.

Unexplained Anemia in the Elderly

Jose C Alvarez-Payares  1 , Sebastián Rivera-Arismendy  1 , Pablo Ruiz-Bravo  2 , Sara M Sánchez-Salazar  2 , Rene A Manzur  1 , Sara I Ramirez-Urrea  3 , Andres Puello  4
Affiliations
Review

Unexplained Anemia in the Elderly

Jose C Alvarez-Payares et al. Cureus. .

Abstract

Anemia is frequently diagnosed in elderly patients, and it is a key indicator of many reactive and clonal conditions. Furthermore, the older age is the most common presenting age for myelodysplastic syndromes (MDS). Anemia in older age may be attributed to an inflammatory state due to senescence, comorbidities, nutritional deficiencies, or primary bone marrow conditions. As diagnostic possibilities and life expectancy increase, the prevalence of anemia of the elderly increases as well. The etiology has a direct impact on the treatment and quality of life of these patients, in whom is a usual clinical challenge as it may be due to a multifactorial origin. In a minority group, when no etiology is identified, it is classified as unexplained anemia (UA) or clonal cytopenia of unknown significance (CCUS). The underlying cause of anemia remains unexplained in 30% of cases, and a great part of unexplained cytopenia may account for myeloid neoplasms. Anemia in the elderly is associated with worse cognitive and functional outcomes and increased mortality.

Keywords: anemia; chronic inflammatory diseases; clonal cytopenia; elderly patient; myelodysplastic syndromes.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Increase of anemia prevalence in older adults
Increase of anemia prevalence in patients with advanced age from a cohort of 19758 inpatient and outpatient visits from university hospitals (modified from Steensma et al. [6])
Figure 2
Figure 2. Possible mechanisms of anemia in elderly adults
(Modified from Shlush [19])
See this image and copyright information in PMC

References

    1. Prevalence of anaemia in older persons: systematic review. Gaskell H, Derry S, Andrew Moore R, McQuay HJ. BMC Geriatr. 2008;8:1. - PMC - PubMed
    1. Evaluation and management of anemia in the elderly. Goodnough LT, Schrier SL. Am J Hematol. 2014;89:88–96. - PMC - PubMed
    1. Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic. Artz AS, Thirman MJ. J Gerontol A Biol Sci Med Sci. 2011;66:925–932. - PubMed
    1. Proposed minimal diagnostic criteria for myelodysplastic syndromes (MDS) and potential pre-MDS conditions. Valent P, Orazi A, Steensma DP, et al. Oncotarget. 2017;8:73483–73500. - PMC - PubMed
    1. Anemia in the elderly: clinical implications and new therapeutic concepts. Stauder R, Thein SL. Haematologica. 2014;99:1127–1130. - PMC - PubMed

LinkOut - more resources