Anemia--a common but never a normal concomitant of aging.

Diagnosis is often overlooked because symptoms develop slowly and insidiously and many patients don't complain about them. Then too, the giddiness, apathy, confusion, clumsiness, and similar problems may be considered simply signs of "old age." Iron deficiency anemia is the most common type in old people. It's usually due to gastrointestinal bleeding, but there may be a second, less obvious cause. The classic picture of low serum iron, high total iron-binding capacity, and low iron-binding saturation is sometimes distorted. Usually, many studies are needed to confirm the suspicion of a vitamin B12 or folic acid deficiency. A raised mean corpuscular volume in itself signals the need for further investigation. In patients with macrocytosis, the bone marrow must be examined. Tests for intestinal malabsorption must be considered too. Repeated blood tests are essential in patients being treated for any type of anemia. Iron deficiency may hide evidence of folate or B12 deficiency. And iron therapy may lessen bleeding from colonic cancer, delaying diagnosis until it's too late to operate.