Takasaki M, Tsurumi N, Konjiki O, Sakurai H, Kanou H, Yanagawa K, Katsunuma H
Department of Geriatrics, Tokyo Medical College.
Nihon Ronen Igakkai Zasshi. 1997 Mar;34(3):171-9. doi: 10.3143/geriatrics.34.171.
Healthy elderly people are mildly anemic peripheral blood data on 3,583 healthy elderly people (1,590 men and 1,993 women aged 65 years or older) from among those undergoing medical examinations at our hospital in the 8 years from 1988 to 1995 were compiled into 5-year age groups. For both men and women the mean values of red blood cell count, hemoglobin, and hematocrit were slightly lower among older subjects. The main causes of this apparent reduction may be a decrease in the number of hematopoietic stem cells and regression of the hematopoietic microenvironment. Observation of arteries in specimens of hematopoietic bone marrow obtained from the spines of elderly people showed arteriosclerotic changes such as greater hypertrophy of the media than of the intima, and adventitial fibrous hypertrophy. The number of venous sinuses was low and the amount of adipose tissue was high compared to the bone marrow of younger people. The cell density and the ratio of hematopoietic tissue to fat tended to be lower in older subjects. The number of erythroid burst-forming units formed after 14 days in culture medium containing erythropoietin was 28 +/- 19 in 32 healthy elderly people, which was significantly lower than the number in 30 young people 54 +/- 30, (p < 0.005). The value for erythroid colony-forming units was 170 +/- 67 in eight healthy people, which was much lower than in young people, 276 +/- 54. In the elderly subjects, the plasma iron disappearance time (PIDT/2) was 60-80 min (mean: 71.9 min), which was similar to that in the young, but the percent red cell iron utilization was 67.6%-84.9% (mean: 79.7%), which was slightly lower than in younger people. When the diagnostic criterion for anemia in the elderly was set at a hemoglobin value of 11.0 g/ dl, about 13% of outpatients who came to our Geriatrics department were found to have anemia, and in most of them the anemia had resulted from another disease. In conclusion, anemia in the elderly is likely to be affected by reduction in the function of various organs and by the decreased reserves associated with aging. The causes of anemia are complex and diagnosis is often difficult. The present article gives a general outline of the diagnosis and treatment of common types of primary and secondary anemia in the elderly.
健康老年人存在轻度贫血 对1988年至1995年8年间在我院接受体检的3583名健康老年人（1590名男性和1993名65岁及以上女性）的外周血数据按5岁年龄组进行了整理。对于男性和女性而言，年龄较大的受试者红细胞计数、血红蛋白和血细胞比容的平均值略低。这种明显降低的主要原因可能是造血干细胞数量减少和造血微环境的退化。对从老年人脊柱获取的造血骨髓标本中的动脉进行观察，发现有动脉硬化变化，如中膜比内膜肥大更明显，以及外膜纤维性肥大。与年轻人的骨髓相比，静脉窦数量少，脂肪组织量高。年龄较大的受试者细胞密度以及造血组织与脂肪的比例往往较低。在含促红细胞生成素的培养基中培养14天后形成的红系爆式集落形成单位数量，32名健康老年人为28±19，明显低于30名年轻人的54±30（p<0.005）。8名健康人的红系集落形成单位值为170±67，远低于年轻人的276±54。在老年受试者中，血浆铁消失时间（PIDT/2）为60 - 80分钟（平均：71.9分钟），与年轻人相似，但红细胞铁利用率百分比为67.6% - 84.9%（平均：79.7%），略低于年轻人。当将老年人贫血的诊断标准设定为血红蛋白值11.0 g/dl时，发现来我院老年科就诊的门诊患者中约13%患有贫血，且其中大多数贫血是由其他疾病引起的。总之，老年人贫血可能受多种器官功能减退以及与衰老相关储备减少的影响。贫血的原因复杂，诊断往往困难。本文概述了老年人常见原发性和继发性贫血类型的诊断和治疗。
