Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: A comprehensive review of the current literature

Iron deficiency anemia(IDA)is common and often under recognized problem in the elderly.It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract.Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel(SB).Capsule endoscopy(CE)provides direct visualization of entire SB mucosa,which was not possible before.It is superior to push enteroscopy,enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA.Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA.The diagnostic yield of CE for IDA progressively increases with advancing age,and is highest among patients over 85 years of age.Balloon assisted enteroscopy is used to treat the lesions seen on CE.CE has some limitations mainly lack of therapeutic capability,inability to provide precise location of the lesion and false positive results.Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly.

Association between Frailty Syndrome and Anemia in Community-Dwelling Elderly

Frailty is an important and complex phenomenon in the fields of geriatrics and gerontology and a highly relevant topic. Frailty syndrome (FS) is a multidimensional clinical condition characterized by loss of physiological and cognitive reserves across multiple organ systems. The Fried frailty phenotype is the main model used to categorize FS. Recent studies have shown an association between anemia, low hemoglobin concentration and frailty. This study aimed to assess the association between FS and anemia in community-dwelling elderly. An observational cross-sectional design was used, with 308 elderly subjects. Most participants were women (78.2%) between 60 and 69 years old (50.6%). The average schooling level was 9.7 years. Anemia was detected in 9.7% of participants. The frequency of frailty, pre-frailty and non-frailty was 8.2, 74.0 and 17.8%, respectively. The multivariate ordinal logistic regression model identified low levels of brain-derived neurotrophic factor (BDNF) (OR = 0.9, 95% CI = 0.9;0.9) as risk factor associated with FS. No significant association was found between frailty and anemia. Moreover, FS may be influenced by low schooling levels, despite the non-significant result obtained in the statistical model. These findings contribute to elucidating other factors associated with FS, especially in community-dwelling elderly.

Mortality and morbidity due to the failure to treat mild anemia unrelated to cancer in elderly Americans—Review of the literature and case presentation

Even mild iron deficiency anemia, as defined by the World Health Organization, is associated with increased mortality and significant morbidity in elderly individuals who are cancer free. Yet, anemia in the elderly is often dismissed as a benign sign of aging. This problem is exacerbated by the fact that elderly individuals often suffer from gastrointestinal complaints that preclude treatment with iron supplements by mouth. The FDA has approved two brands of injectable iron for treating such patients. Nonetheless, a major American health maintenance organization refuses to treat elderly patients with injectable iron, even when it is indicated, unless their anemia is associated with cancer. This may well reflect a public health crisis afflicting many elderly residents of the United States.

Prevalence of Anemia among Community Dwelling Elderly in Dakahlia as a Representative of Rural Areas in Egypt and Its Impact on Their Functional Status

Background: Anemia is a common problem with serious consequences in older person but is often overlooked despite considerable evidence that low hemoglobin levels indicate physiologic decline in these patients. Multiple studies demonstrate that anemia is an independent risk factor for increased morbidity and mortality, and decreased quality of life in community-dwelling older persons. Increasing functional deterioration is associated with decreasing hemoglobin concentration in an inverse and linear manner. Aim: to assess the prevalence of anemia in free-living elderly subjects living in an urban community of Meet Abbad-Nabaroh, Dakahlia. Egypt and its impact on their functional level. Methodology: A cross-sectional study was done including 93 elderly ≥ 60 ys old, both males and females recruited from Meet Abbad-Nabaroh, Dakahlia, Egypt. All subjects underwent a complete medical history taking, clinical evaluation then blood hemoglobin level was measured, and anemia was defined according to the World Health Organization definition of anemia (hemoglobin level less than 13 g per dL [130 g per L] in men and less than 12 g per dL [120 g per L] in women). Results: The study revealed that the prevalence of anemia is 15.05% among the studied participants (14.5% among the male group and 16.1% among females), 14% had mild anemia and 1% had moderate anemia, with significant increase with age as there was significant difference (p = 0.042) between the different age groups of the studied participants, also history of blood loss and anemia showed positive significant correlation (p-value = 0.001), and highly significant correlations between intake of non steroidal anti inflammatory drugs (NSAID) and anemia (p-value = 0.000). The impact of anemia on functional status and risk of fall respectively showed significant difference between anemic and non anemic as regards instrumental activity of daily living (IADL) (p = 0.007), and timed up and go test (p-value = 0.01), also there is significant correlation between anemia and mini mental state examination (MMSE) (p-value 0.046) with worse performance among the anemic ones. Conclusion & Recommendation: anemia represents a health problem of significance among the community dwelling elderly with bad drawback on their functional level;their need for health & community services has a financial impact so this problem needs more assessment for better prevention and treatment.

Anemia in the Elderly: Neuropsychiatric Repercussions

The purpose of this review is to evaluate the role of chronic anemia on neuropsychiatric symptoms and conditions among the elderly. Anemia is defined as hemoglobin levels below 120 and 130 g/L for women and men, respectively. Anemia is not a consequence of the aging process. It is common in the elderly and easily overlooked. Nevertheless, chronic anemia is a risk factor associated with increased mortality, several geriatric syndromes including functional and cognitive impairments. Investigations have shown that anemic elderly and those with hemoglobin borderline levels may present higher proportion of neuropsychiatric impairment, such as Executive Function Disorder and Alzheimer disease. The association between anemia and depression is well established, but its causal pathway is not known: anemia can be regarded as cause or consequence of depression. There is evidence that dementia due to anemia can be prevented;renal chronic anemic patients who received erythropoietin (EPO) replacement therapy showed a lower risk for dementia, compared to those who did not receive it. Anemia may be associated with chronic psychiatric diseases such as bipolar disorders and cause their symptoms to become more severe.

Anemia in the Elderly: Frequency and Etiologies at University Hospital Center of Point G

Introduction: Older people are exposed to particular health problems that must be taken into account, including anemia defined by the World Health Organization (WHO) in people aged 65 and over hemoglobin < 13 g/dl in men and < 12 g/dl in women. Objectives: To determine the frequency of anemia, to describe its clinical and paraclinical aspects, and to determine the etiologies. Material and Methods: We conducted a cross-sectional study with prospective data collection that took place in the Department of Internal Medicine of the Point G CHU in Mali from January 1st, 2018 to August 31st, 2018, covering all elderly patients. At least 65 years old hospitalized and/or having consulted and presenting with anemia. Anemia was defined as Hb < 13 g/dl in men and < 12 g/dl in women (WHO definition). Biological markers were collected at admission. Results: Anemia was observed in 42 patients in 160 elderly patients, a prevalence of 26%, the age of our patients ranged from 65 to 90 years. The sex ratio was 1.33. Fifty percent (50%) of the patients had high blood pressure as antecedents. Weight loss was found in 69% of cases;47.6% of patients had dyspnea on admission. Tachycardia was the physical sign associated with anemia present in 85.7% of them. The mean hemoglobin level was 9.2 g/dl ± 2.03: thus 50% of the subjects had microcytic and or hypochromic anemia. The etiologies found were infectious in 31.0% of cases, inflammatory in 31.0% of cases, renal in 14.2% of cases. Chronic hemorrhage, acute haemorrhage, hemolysis accounted for 2.4% each. We observed 9.5% of unexplained causes. Conclusion: The frequency of anemia is high. Nearly half of the geriatric population has anemia. The lack of means and the nonperformance of the technical platform to perform all examinations in the etiological research of anemia have a significant impact on the rate of unexplained anemias.

Iron-Restricted Erythropoiesis in a Population of Elderly Hospitalized Anemic Patients

The aim of this observational study was to assess the prevalence of iron-restricted erythropoiesis (IRE) in a population of elderly hospitalized anemic patients. Prevalence of IRE was found to be 41% and the most common clinical diagnoses in such patients were hematologic malignancies and solid tumors. Comparison between patients with IRE and non-IRE patients revealed that mean corpuscular volume, mean corpuscular hemoglobin, iron, and transferrin saturation were significantly lower in the IRE group, whereas no significant difference was found for Hb, transferrin, or ferritin. There was a more pronounced inflammatory response in the IRE group demonstrated by a higher C-reactive protein level.

An extensive DeBakey type IIIb aortic dissection with massive right pleural effusion presenting as abdominal pain and acute anemia： particular case report

We describe the case of a 79-year-old male presented with sudden onset of abdominal pain and mild breathlessness, and complicated acute progressive anemia with haemoglobin which declined from 120 g/L to 70 g/L within five days. An urgent computed tomography an- giography showed acute thoracic aortic dissection, DeBakey type IIIb, a dissecting aneurysm in the proximal descending thoracic aorta start- ing immediately after the origin of the left subclavian artery and extending distally below the renal arteries with evidence of rupture into the right pleural cavity for massive pleural effusion. Plasma D-dimer, brain natriuretic peptide and C reactive protein level were elevated. Our case showed that D-dimer can be used as a ＇rule-out＇ test in patients with suspected aortic dissection. A raised BNP may exert a protective role through anti-inflammatory endothelial actions in the systemic circulation.

老年人贫血影响因素和改善措施研究进展

老年贫血是老龄化趋势下需要给予极大关注的公共卫生问题。贫血可使老年人体力活动受限、认知能力障碍、生活质量下降、住院率和死亡率增加。贫血的病因复杂多样,对老年人而言,因各种疾病引起的贫血所占比例较高,但其发病机制复杂,而营养性贫血病因较为明确,并且是可以预防和治疗的。通过改善营养状况,可降低老年人的贫血患病率,对提高老年人生活质量,促进社会的健康老龄化有着重要意义。

老年人巨幼细胞性贫血40例临床分析

目的探讨老年人巨幼细胞性贫血临床特点。方法对我院1995～2001年收治的40例60岁以上巨幼细胞性贫血住院患者的资料进行分析。结果40例中男12例、女28例,年龄60～85岁。因维生素B12减少者36例,占90%。多伴有其它慢性疾病,以慢性消化道疾病居多(20例),占50%。属中、重度贫血30例,占75%。病程中合并感染8例,占20%。用叶酸、维生素B12治疗效果显著。结论老年人巨幼细胞性贫血近年有增加趋势,以城镇居民多见。其发生与消化道疾病关系密切,贫血多较严重,及时诊断和治疗预后良好。

老年贫血的临床分析

目的:探讨老年人贫血的原因及贫血对老年人生存的影响,提高对老年人贫血的认识。方法:回顾性分析临床确诊的163例老年贫血患者的临床资料。结果:老年贫血原因前3位分别为缺铁性贫血(19.6%)、慢性病贫血(19.0%)、骨髓异常综合征(16.0%)。老年人随着血红蛋白的下降死亡率会上升。结论:老年人贫血病因复杂,且影响老人生存寿命,我们要高度重视,尽量早期发现,明确原因,及时预防和治疗,提高老年人生活质量。

Research on stage of chronic kidney disease in elderly patients

Objective To explore the clinical value of glomerular filtration rate (GFR) 45 ml·min-1·1.73 m-2for the stage assessment in the elderly patients with chronic kidney disease (CKD) .Methods From June 2009 to December 2011,2258 patients were recruited and

Aplastic anemia with macrocytic anemia:a study based on long-term follow-up

Objective To elucidate the clinical features,response rate,prognosis and clonal evolution of aplastic anemia(AA)with macrocytic anemia(mAA).Methods The clinical features at initial diagnosis and

小剂量利妥昔单抗治疗老年自身免疫性溶血性贫血的临床研究

目的探讨小剂量利妥昔单抗治疗老年溶血性贫血的疗效及安全性。方法以37例初诊老年自身免疫性溶血性贫血（AIHA）患者为研究对象，对25例患者应用泼尼松1mg·kg^-1·d^-1，4周后评估疗效。对12例因合并各种疾病不能使用泼尼松治疗患者应用利妥昔单抗，每次100mg，每周1次，连用4次后评估疗效。结果25例泼尼松治疗患者中，完全缓解5例，部分缓解15例，无效5例，完全缓解率20．0％，有效率80．0％。12例给予小剂量利妥昔单抗治疗患者中，完全缓解8例，部分缓解3例，无效1例，完全缓解率66．7％，有效率91．7％。小剂量利妥昔单抗治疗组完全缓解率明显高于泼尼松组，差异有统计学意义（P=0．038）。结论小剂量利妥昔单抗治疗老年AIHA患者安全性、有效性均优于泼尼松。

我国广西农村老年妇女贫血影响因素的病例对照研究

目的研究广西农村老年妇女贫血的影响因素。方法采用1：1配对的病例对照研究，对广西巴马县农村地区60～75岁老年妇女进行血红蛋白筛查后，确定病例（指血血红蛋白为95～125g／L）、对照（指血血红蛋白〉135g／L）各120例作为研究对象，对两组的一般状况、体格指标、膳食情况进行调查，测定相关血液生化指标。结果病例组的血红蛋白、体重、腰围、体质指数（BMI）显著低于对照组，差异均有统计学意义（P〈0．05，P〈0．叭）。膳食调查中病例组的主食、动物性食物摄入量显著低于对照组，动物性食物亚组中病例组肉禽类摄人量显著低于对照组，差异均有统计学意义（P〈0．05）；膳食模式评分中病例组的膳食平衡指数负端分（DBI_LBS）、主食和动物性食物的DBI显著高于对照组，差异有统计学意义（P〈O．05）；营养素摄入量中病例组的能量、蛋白质、维生素A显著低于对照组，差异均有统计学意义（P〈O．05）；病例组的血清铁、铁蛋白、白蛋白、转铁蛋白、转铁蛋白饱和度均低于对照组，病例组血沉显著高于对照组，差异均有统计学意义（P〈O．05）。多因素条件Logistic回归分析显示，DBI—LBS是贫血的危险因素（OR=2．2，95％CI：1．2～4．2），而维生素A、铁蛋白和转铁蛋白均为贫血的保护因素（OR值分别为0．2、0．4、0．4，95％C1分别为0．1～0．4、0．2～0．8、0．2～0．7）。结论提高整体的膳食质量，调整膳食结构，增加富含血红素铁和维生素A的动物性食物有利于改善广西巴马老年妇女贫血状况。

贫血对老年慢性心力衰竭患者预后的影响

【目的】探讨贫血对老年心衰患者预后的影响,并探讨其治疗方法。【方法】随机选取老年慢性心衰患者106例,分为贫血组及非贫血组,比较血红蛋白水平、左室射血分数、彩超左室舒张末期内径等指标,分析其相关性。电话随访24个月,分析患者因心衰住院次数、心衰分级、死亡率等指标。分析老年心衰患者贫血的发生与非贫血患者是否有差别,评价贫血对老年心衰患者预后的影响。【结果】老年心衰患者106例,其中贫血组47例,非贫血组59例,心功能Ⅰ级19例,心功能Ⅱ级26例,心功能Ⅲ级34例,心功能Ⅳ级27例,贫血与心衰程度具有相关性,随着心衰分级的增高,贫血发生率增高,与非贫血组对比差异有统计学意义(P<0.05);在贫血组内不同心功能对比,Ⅳ级心功能贫血发生率高于Ⅱ级及Ⅲ级心功能组,差异有统计学意义(P<0.01;P<0.01);贫血组老年心衰患者死亡率及随访期内住院次数明显高于非贫血组(P<0.05);贫血组平均住院时间长于非贫血组,差异有统计学意义(P<0.05)。【结论】老年心衰患者贫血的严重程度与心衰程度呈正相关,贫血增加了老年心衰患者的死亡率和心衰入院的风险。

老年巨幼细胞性贫血68例

目的探讨老年人巨幼细胞性贫血的病因,临床特点及治疗效果。方法对68例老年巨幼细胞性贫血患者的发病原因,临床特征及疗效进行回顾分析。结果主要病因是营养摄入不足,临床发病过程缓慢,症状隐匿不典型,表现多样,易误诊误治。叶酸、维生素B12治疗效果及预后良好。