Joosten Etienne
Department of Internal Medicine, Geriatric Medicine, University Hospitals K.U. Leuven, Belgium.
Gerontology. 2004 Mar-Apr;50(2):49-56. doi: 10.1159/000075555.
Anaemia is a common medical problem in elderly patients and is associated with an increased mortality and morbidity risk and a reduced quality of life. It is not known at which exact haemoglobin level investigations should be initiated in order to optimize the diagnostic efficacy. Serum ferritin determination remains the most accurate laboratory test for the diagnosis of iron deficiency anaemia and its differential diagnosis with the anaemia of chronic disease. The introduction of the metabolites methylmalonic acid and homocysteine has made it possible to diagnose vitamin B(12) and folate deficiencies at an early subclinical stage, even without neurological and haematological symptoms, but the clinical importance of this 'biochemical' diagnosis is unclear. Other causes of anaemia, such as myelodysplastic syndromes and chronic renal insufficiency, will become more and more common in the elderly because of the ageing of the population. Although erythropoietin analysis has no clear diagnostic value at the moment, it has become more and more obvious that its therapeutic importance in elderly patients with chronic anaemia is increasing. A substantial number of patients have an unexplained anaemia. Whether this is disease related, or may be attributed to an age-related anaemia, is still a matter of debate, but it is advisable to perform an extensive laboratory, cytogenetic, and morphological investigation before one should assess the anaemia as unexplained.
贫血是老年患者常见的医学问题，与死亡率和发病率风险增加以及生活质量下降相关。目前尚不清楚应在哪个确切的血红蛋白水平开始进行检查，以优化诊断效果。血清铁蛋白测定仍然是诊断缺铁性贫血及其与慢性病贫血进行鉴别诊断最准确的实验室检查。代谢产物甲基丙二酸和同型半胱氨酸的引入使得即使在没有神经和血液学症状的情况下，也能够在亚临床早期诊断维生素B12和叶酸缺乏，但这种“生化”诊断的临床重要性尚不清楚。由于人口老龄化，贫血的其他原因，如骨髓增生异常综合征和慢性肾功能不全，在老年人中会越来越常见。虽然目前促红细胞生成素分析没有明确的诊断价值，但越来越明显的是，其在老年慢性贫血患者中的治疗重要性正在增加。相当一部分患者患有不明原因的贫血。这是与疾病相关，还是可能归因于与年龄相关的贫血，仍存在争议，但在将贫血评估为不明原因之前，建议进行广泛的实验室、细胞遗传学和形态学检查。
