Geriatric Anemia Flashcards
WHO definition of anemia
men: HgB
Highest and lowest rates of anemia (race)
nonhispanic blacks - highest
non hispanic whites - lowest
Commonly reported symptoms of anemia in elderly
fatigue, weakness, dyspnea
can worsen symptoms of other comorbid conditions (dyspnea from CHF)
What physical exam sign is a reliable sign of anemia in the elderly and noted in patients with Hgb
conjuntival pallor
glossitis, decreased vibratory sense, ataxia, paresthesia, confusion, dementia, pearly gray hair
vitamin b12 deficiency
Difference between vitamin b12 and folate deficiency
both present similarly but folate deficiency doesn’t have neurologic deficits…folate usually seen in alcoholics
koilomychias (spoon nails), glossitis, dysphagia
severe iron deficiency
anemia with jaundice
hemolysis
anemia with splenomegaly
thalassemia/neoplasm?
What is the initial workup for suspected anemia?
CBC with measurement of RBC indices, peripheral smear, and reticulocyte count
Most common cause of anemia with low MCV
iron deficiency
in elderly this is due to chronic GI blood loss, poor nutrition, or bleeding disorder
What lab results would you expect to see in iron deficiency?
low serum iron, low ferritin, high TIBC
Iron deficiency can be initial presentation of what kind of malignancy
GI (so get those upper and lower GI endoscopies done!)
Anemias with high MCV
folate or vitb12 deficiency (most common)
drug effects, liver dx, or hypothyroidism (less common)
What labs indicate vitb12 and folate deficiency
vitb12 - elevated MMA (methylmalonic acid)
folate - elevated homocysteine
Most common cause of normocytic anemia in elderly
anemia of chronic inflammation (aka chronic disease)
How to differentiate between iron deficiency and anemia of chronic inflammation
iron deficiency - high TIBC, low ferritin
chronic disease- low TIBC, normal/high ferritin
can also use bone marrow iron store
Threshold for RBC transfusion
Hgb
treatment for iron deficiency anemia
oral iron (ferrous sulfate TID) plus correction of any source of blood loss…may need up to 6-8 weeks for treatment,
may need to give parental administration in patients with malabsorption, malignancy, or CKD and heart failure
how to treat vitb12 deficiency or folate
IM b12 or folate…duh
treatment for anemia of chronic inflammation
treat underlyin condition
if anemia severe enough…RBC transufsion or erythropoesis stimulating agents
goal in CKD patients - between 10-12 hgb
Most common cause of vitb12 deficiency
pernicious anemia (lack of intrinsic factor)
