Original article| Volume 23, ISSUE 6, P524-528, September 2012

Anaemia in the elderly: An aetiologic profile of a prospective cohort of 95 hospitalised patients

Published:April 16, 2012DOI:


      Background and objectives

      Anaemia is a significant problem in the elderly, and the cause of anaemia in approximately one third of the general population is unidentified. To date, only a few studies have focused on hospitalised patients.

      Patients and methods

      We prospectively included anaemic patients (according to OMS criteria) aged 65 years and older who were hospitalised in the internal medicine department. The typical clinical data were collected, and a standardised set of biological tests, including cupraemia was performed.


      Of 360 total patients, 191 (53%) patients were anaemic; however, 96 patients were excluded because their data were incomplete. Of the remaining 95 patients that were included, 45 were men (47.4%) and 50 were women (52.6%); the mean patient age was 79.7 years (66–101 years). At least one cause of anaemia was diagnosed in 87 of the 95 (91.6%) patients, and anaemia was multifactorial in 44 of the 95 (46.3%) cases. The five most prominent causes of anaemia were inflammation (62.1%), iron deficiency (30.5%), folic acid deficiency (21%), chronic renal failure (17.9%) and cobalamin deficiency (11.6%). Microcytosis was present in only 27.5% of the patients who had an iron deficiency, and macrocytosis was present in only 7.4% of the patients who had a folic acid and/or cobalamin deficiency. The cause of anaemia could not be identified for 8 of the patients. The cupraemia was normal in all the patients.


      A predefined protocol for older hospitalised patients was ability to identify the aetiology of anaemia in 91.6% of the cases; strikingly, anaemia was frequently caused by more than one factor (43.5%). Diagnostic orientation based on the mean corpuscular volume does not appear to correlate with mean cellular volume profile. Finally, anaemia caused by an unknown aetiology is rare and copper deficiency was not documented in any case.


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        • Guralnik J.M.
        • Eisenstaedt R.S.
        • Ferrucci L.
        • Klein H.G.
        • Woodman R.C.
        Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia.
        Blood. 2004; 104: 2263-2268
        • Patel K.V.
        Epidemiology of anemia in older adults.
        Semin Hematol. 2008; 45: 210-217
        • Joosten E.
        • Lemiengre J.
        • Nelis T.
        • Verbeke G.
        • Milisen K.
        Is anemia a risk factor for delirium in an acute geriatric population?.
        Gerontology. 2006; 52: 382-385
        • Zamboni V.
        • Cesari M.
        • Zuccala G.
        • Onder G.
        • Woodman R.C.
        • Maraldi C.
        • et al.
        Anemia and cognitive performance in hospitalized older patients: results from the GIFA study.
        Int J Geriatr Psychiatry. 2006; 21: 529-534
        • Darmarajan T.S.
        • Avula S.
        • Norkus E.P.
        Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized ambulatory, long term care, and community patients.
        J Am Med Dir Assoc. 2006; 7: 287-293
        • Riva E.
        • Tettamanti M.
        • Mosconi P.
        • Apolone G.
        • Gandini F.
        • Nobili A.
        • et al.
        Association of mild anemia with hospitalization and mortality in the elderly: the health and anemia population-based study.
        Haematologica. 2009; 94: 22-28
        • den Elzen W.P.
        • Willems J.M.
        • Westendorp R.G.
        • de Craen A.J.
        • Assendelft W.J.
        • Gussekloo J.
        Effect of anemia and comorbidity on functional status and mortality in old age: results from the Leiden 85-plus study.
        CMAJ. 2009; 181: 151-157
        • Thein M.
        • Ershler W.B.
        • Artz A.S.
        • Tecson J.
        • Robinson B.E.
        • Rothstein G.
        • et al.
        Diminished quality of life and physical function in community-dwelling elderly with anemia.
        Medicine (Baltimore). 2009; 88: 107-114
        • Terrier B.
        • Andrès E.
        • Bonnet F.
        • Hachulla E.
        • Marie I.
        • Rosenthal E.
        • et al.
        Prévalence, prise en charge et signification pronostique de l'anémie en médecine interne: résultats de l'enquête prospective multicentrique GRAMI 2008–2009.
        Rev Med Interne. 2010; 31: S372
        • Price E.A.
        • Mehra R.
        • Holmes T.H.
        • Schrier S.L.
        Anemia in older persons: etiology and evaluation.
        Blood Cells Mol Dis. 2011; 46: 159-165
        • Haddad A.S.
        • Subbiah V.
        • Lichtin A.E.
        • Theil K.S.
        • Maciejewski J.P.
        Hypocupremia and bone marrow failure.
        Haematologica. 2008; 93: e1-e5
        • Guyatt G.H.
        • Patterson C.
        • Ali M.
        • Singer J.
        • Levine M.
        • Turpie I.
        • et al.
        Diagnosis of iron-deficiency anemia in the elderly.
        Am J Med. 1990; 88: 205-209
        • Andrès E.
        • Loukili N.H.
        • Noel E.
        • Kaltenbach G.
        • Ben Abdelgheni M.
        • Perrin A.E.
        • et al.
        Vitamin B12 (cobalamin) deficiency in elderly patients.
        CMAJ. 2004; 171: 251-259
        • Weiss G.
        • Goodnough L.T.
        Anemia of chronic disease.
        N Engl J Med. 2005; 352: 1011-1023
        • Astor B.C.
        • Muntner P.
        • Levin A.
        • Eustace J.A.
        • Coresh J.
        Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey 1988–1994.
        Arch Intern Med. 2002; 162: 1401-1408
        • Chassagne P.
        • Verdonck A.
        • Druesne L.
        • Landrin-Dutot I.
        • Ménard J.F.
        • Doucet J.
        • et al.
        Normocytic anemia in the elderly. Should the cause of anemia systematically investigated independently of hemoglobin concentration.
        Rev Med Interne. 2004; 25: 189-194
        • Thurnham D.I.
        • McCabe L.D.
        • Haldar S.
        • Wieringa F.T.
        • Northrop-Clewes C.A.
        • McCabe G.P.
        Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis.
        Am J Clin Nutr. 2010; 92: 546-555
        • Joosten E.
        Prevalence and causes of anemia in a geriatric hospitalized population.
        Gerontology. 1992; 38: 111-117
        • Andrès E.
        • Mecili M.
        Anemia in elderly patients.
        Blood Transfus. 2011; 9: 108-109
        • Rimon E.
        • Levy S.
        • Sapir A.
        • Gelzer G.
        • Peled R.
        • Ergas D.
        • et al.
        Diagnosis of iron deficiency anemia in the elderly by transferrin receptor-ferritin index.
        Arch Intern Med. 2002; 162: 445-449
        • Mast A.E.
        • Blinder M.A.
        • Gronowski A.M.
        • Chumley C.
        • Scott M.G.
        Clinical utility of the soluble transferrinn receptor and comparison with serum ferritin in several populations.
        Clin Chem. 1998; 44: 45-51
        • Davis S.L.
        • Littlewood T.J.
        The investigation and treatment of secondary anaemia.
        Blood Rev. 2012; 26: 65-71
        • Goodnough L.T.
        • Nemeth E.
        • Ganz T.
        Detection, evaluation and management of iron-restricted erythropoiesis.
        Blood. 2010; 116: 4754-4761
        • van Santen S.
        • van Dongen-Lases E.C.
        • de Vegt F.
        • Laarakkers C.M.
        • van Riel P.L.
        • van Ede A.E.
        • et al.
        Hepcidin and hemoglobin content parameters in the diagnosis of iron deficiency in rheumatoid arthritis patients with anemia.
        Arthritis Rheum. 2011; 63: 3672-3680
        • Vitale G.
        • Fatti L.M.
        • Prolo S.
        • Girola A.
        • Caraglia M.
        • Marra M.
        • et al.
        Screening for hypothyroidism in older hospitalized patients with anemia: a new insight into an old disease.
        J Am Geriatr Soc. 2010; 58: 1825-1827
        • Artz A.S.
        • Thirman M.J.
        Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic.
        J Gerontol A Biol Sci Med Sci. 2011; 66: 925-932
        • Vanasse G.J.
        • Berliner N.
        Anemia in elderly patients: an emerging problem for the 21st century.
        Hematology Am Soc Hematol Educ Program. 2010; 2010: 271-275
        • Perlstein T.S.
        • Pande R.
        • Berliner N.
        • Vanasse G.J.
        Prevalence of 25-hydroxyvitamin D deficiency in subgroups of elderly persons with anemia: association with anemia of inflammation.
        Blood. 2011; 117: 2800-2806