IDENTIFICATION AND TREATMENT OF ANEMIA IN OLDER PATIENTS

Anaemia in elderly patients should never be regarded as a normal physi ological response to aging. Underlying causes must be investigated and treated in a similar;manner to that used in younger adults. In additi on to a thorough history and physical examination, basic investigation s such as red cell indices and morphology, reticulocyte count, haemati nic assays and occasionally bone marrow examination, will detect the u nderlying pathology in most cases. Anaemia may be classified, accordin g to red blood cell mean corpuscular volume, into microcytic, macrocyt ic and normocytic types. Anaemia with an absolute reticulocytosis is d ue either to acute blood loss or haemolysis. Other anaemias, more freq uently encountered in elderly patients, are hypoproliferative, and ref lect depressed marrow production or impaired erythroid maturation. Exa mples include anaemia of chronic disease and iron deficiency and, less commonly, megaloblastic anaemia and anaemia due to primary bone marro w failure. The treatment of anaemia should aim to correct the underlyi ng cause of the disorder and/or to improve the quality of the blood, e .g. by haematinic replacement therapy. Recombinant human erythropoieti n has revolutionised the treatment of anaemia associated with chronic renal failure, while its role in other anaemias is currently under inv estigation. Regular blood transfusion may be required for some elderly patients with chronic anaemia. However, the attendant risks of this p rocedure, such as iron overload and viral hepatitis transmission, must be considered.