Section of Hematology/Oncology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60605, USA.
J Gerontol A Biol Sci Med Sci. 2011 Aug;66(8):925-32. doi: 10.1093/gerona/glr090. Epub 2011 Jun 9.
To accurately determine the causes of anemia and proportion of unexplained anemia in a racially diverse cohort of older adults after a comprehensive and standardized evaluation.
We evaluated results from a single-institutional university anemia clinic. Patients with anemia, defined as a hemoglobin less than 13.0 g/dL for men and less than 12.0 g/dL for women, underwent a prospective standardized history, physical examination, and laboratory measures, with additional studies including bone marrow examination as indicated. Empiric treatment trials were given for identified deficiencies.
One hundred and seventy-four primarily community-dwelling adults aged 65 years and older were evaluable. African Americans accounted for 69% of patients and whites were 27%. Anemia etiologies included iron deficiency anemia at 25.3%, anemia of chronic inflammation at 9.8%, and hematologic malignancy in 7.5%. Unexplained anemia in the elderly accounted for 43.7% and predominated in both African Americans and whites. The prevalence of iron deficiency anemia and hematologic malignancies did not differ by race. Unexplained anemia in the elderly showed a consistent phenotype composed of a hypoproliferative mild-to-moderate anemia with suppressed serum erythropoietin. Specifically, erythropoietin levels showed no correlation with hemoglobin concentration in unexplained anemia in the elderly (r = -.15, p = .19) as opposed to iron deficiency anemia (r = -.63, p < .0001).
In summary, an intensive hematologic evaluation reveals a wide number of anemia etiologies among older adults, including 7.5% with hematologic malignancies; nevertheless, unexplained anemia in the elderly prevails as the most common category in whites and African Americans.
在对种族多样化的老年人群进行全面和标准化评估后，准确确定贫血的原因和不明原因贫血的比例。
我们评估了一家机构性大学贫血诊所的结果。贫血定义为男性血红蛋白<13.0 g/dL，女性血红蛋白<12.0 g/dL，对患者进行前瞻性标准化的病史、体格检查和实验室检查，根据需要进行骨髓检查等额外研究。对已确定的缺乏症进行经验性治疗试验。
174 名主要居住在社区的 65 岁及以上成年人可评估。非裔美国人占患者的 69%，白人为 27%。贫血病因包括缺铁性贫血占 25.3%，慢性炎症性贫血占 9.8%，血液恶性肿瘤占 7.5%。老年人不明原因贫血占 43.7%，在非裔美国人和白人中均占多数。种族之间铁缺乏性贫血和血液恶性肿瘤的患病率没有差异。老年人不明原因贫血表现为一种以低增生性轻度至中度贫血为主的一致表型，伴有血清促红细胞生成素受抑制。具体来说，与缺铁性贫血（r = -.63，p <.0001）相反，老年人不明原因贫血中促红细胞生成素水平与血红蛋白浓度无相关性（r = -.15，p =.19）。
总之，强化血液学评估揭示了老年人中存在多种贫血病因，包括 7.5%的血液恶性肿瘤；然而，老年人不明原因贫血仍是白人和非裔美国人中最常见的类别。
