Anemia in the elderly. Symptoms, causes, and therapies.

Anemia is common in the elderly, but it is not a normal manifestation of aging and should be evaluated as it would be in a younger person. History taking, physical examination, assessment of red cell morphology, and simple laboratory evaluations (ie, reticulocyte count, iron studies, vitamin levels, sometimes bone marrow examination) usually elucidate the cause. Hypoproliferation of red cells is the most common form of anemia in the elderly, caused more often by chronic disease or iron deficiency and less often by vitamin deficiencies or bone marrow infiltration. Anemia with an elevated reticulocyte count, seen less often in the elderly, suggests acute blood loss or hemolysis. In some patients, the cause is not obvious, and anemia is likely due to increased sensitivity of the hematopoietic system to multiple insults and decreased homeostatic reserve. Transfusions should be used judiciously in patients with symptomatic anemia who are likely to benefit from increased oxygen delivery after transfusion.