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      Unexplained anemia in the elderly – a real life analysis of 981 patients

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          Abstract

          Introduction

          We aimed to analyze the prevalence of unexplained anemia (UA) and assess its characteristics, potential causes and impact on survival in an elderly population.

          Material and methods

          Medical files of 981 patients aged ≥ 60 years consulted in one primary medical clinic in Poland in 2013–2014 were retrospectively analyzed. Anemia, defined according to WHO criteria, diagnosed during either hospitalization or outpatient treatment, from the age of 60, was included. Unexplained anemia was diagnosed if, based on available clinical data and laboratory tests and other assessments in medical records, none of the well-known types of anemia were identified.

          Results

          Of 981 patients with anemia, UA was found in 48 (28.4%) patients (4.9% of those studied) and incidence increased with age (≥ 80 years, 12.3%). In 81.3% no full hematological diagnostics were performed. Patients with UA, as with those with defined anemia, when compared to the group without anemia were older, had more co-morbidities, were more frequently hospitalized, more frequently had dementia syndrome and obtained lower Barthel scores ( p < 0.0001). In the groups of patients with UA and defined anemia, there were more deaths than in those without anemia (10% vs. 13% vs. 2%, p < 0.0001) with significant differences in survival rates observed during 3-year follow-up.

          Conclusions

          The increasing incidence with age of UA in the elderly population, insufficient diagnosis and the higher mortality of patients with UA in comparison to the group without anemia indicate the need to develop recommendations for its management by primary care physicians.

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          Most cited references38

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          Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia.

          Clinicians frequently identify anemia in their older patients, but national data on the prevalence and causes of anemia in this population in the United States have been unavailable. Data presented here are from the noninstitutionalized US population assessed in the third National Health and Nutrition Examination Survey (1988-1994). Anemia was defined by World Health Organization criteria; causes of anemia included iron, folate, and B(12) deficiencies, renal insufficiency, anemia of chronic inflammation (ACI), formerly termed anemia of chronic disease, and unexplained anemia (UA). ACI by definition required normal iron stores with low circulating iron (less than 60 microg/dL). After age 50 years, anemia prevalence rates rose rapidly, to a rate greater than 20% at age 85 and older. Overall, 11.0% of men and 10.2% of women 65 years and older were anemic. Of older persons with anemia, evidence of nutrient deficiency was present in one third, ACI or chronic renal disease or both was present in one third, and UA was present in one third. Most occurrences of anemia were mild; 2.8% of women and 1.6% of men had hemoglobin levels lower than 110 g/L (11 g/dL). Therefore, anemia is common, albeit not severe, in the older population, and a substantial proportion of anemia is of indeterminate cause. The impact of anemia on quality of life, recovery from illness, and functional abilities must be further investigated in older persons.
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            Nutritional anaemias. Report of a WHO scientific group.

            (1967)
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              Clinical significance of somatic mutation in unexplained blood cytopenia.

              Unexplained blood cytopenias, in particular anemia, are often found in older persons. The relationship between these cytopenias and myeloid neoplasms like myelodysplastic syndromes is currently poorly defined. We studied a prospective cohort of patients with unexplained cytopenia with the aim to estimate the predictive value of somatic mutations for identifying subjects with, or at risk of, developing a myeloid neoplasm. The study included a learning cohort of 683 consecutive patients investigated for unexplained cytopenia, and a validation cohort of 190 patients referred for suspected myeloid neoplasm. Using granulocyte DNA, we looked for somatic mutations in 40 genes that are recurrently mutated in myeloid malignancies. Overall, 435/683 patients carried a somatic mutation in at least 1 of these genes. Carrying a somatic mutation with a variant allele frequency ≥0.10, or carrying 2 or more mutations, had a positive predictive value for diagnosis of myeloid neoplasm equal to 0.86 and 0.88, respectively. Spliceosome gene mutations and comutation patterns involving TET2, DNMT3A, or ASXL1 had positive predictive values for myeloid neoplasm ranging from 0.86 to 1.0. Within subjects with inconclusive diagnostic findings, carrying 1 or more somatic mutations was associated with a high probability of developing a myeloid neoplasm during follow-up (hazard ratio = 13.9, P < .001). The predictive values of mutation analysis were confirmed in the independent validation cohort. The findings of this study indicate that mutation analysis on peripheral blood granulocytes may significantly improve the current diagnostic approach to unexplained cytopenia and more generally the diagnostic accuracy of myeloid neoplasms.
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                Author and article information

                Journal
                Arch Med Sci
                Arch Med Sci
                AMS
                Archives of Medical Science : AMS
                Termedia Publishing House
                1734-1922
                1896-9151
                05 February 2019
                2020
                : 16
                : 4
                : 834-841
                Affiliations
                [1 ]Department of Pharmacology and Toxicology, Faculty of Medicine and Health Science, University of Zielona Gora, Zielona Gora, Poland
                [2 ]Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
                [3 ]Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
                Author notes
                Corresponding author: Sylwia S. Michalak PhD, Department of Pharmacology and Toxicology, Faculty of Medicine and Health Science, University of Zielona Gora, 28 Zyty St, 65-046 Zielona Gora, Poland, Phone: +48 502 857 453, E-mail: s.michalak@ 123456wlnz.uz.zgora.pl
                Article
                35774
                10.5114/aoms.2019.82723
                7286331
                32542085
                df2cbf05-25a7-47a6-831b-a2607be173de
                Copyright © 2019 Termedia & Banach

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License ( http://creativecommons.org/licenses/by-nc-sa/4.0/)

                History
                : 02 December 2018
                : 06 January 2019
                Categories
                Clinical Research

                Medicine
                elderly,survival,unexplained anemia
                Medicine
                elderly, survival, unexplained anemia

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