Q: I'm 80 years old, and I'm always very tired and short of
breath. My doctor says I have low hemoglobin, but my iron level is OK. The
problem is my bone marrow is not producing. What should I do now?
You have stated that you have anemia (a low hemoglobin
concentration, less than 12 g/dl) that does not result from iron deficiency.
Anemia is in fact a common problem among older adults.
Anemia is diagnosed by a complete blood count. Other tests might
include further blood work to evaluate iron, ferritin, Vitamin B12 levels, folic
acid, and lactic dehydrogenase; and an electrophoresis of the proteins in the
serum. A bone marrow biopsy and aspirate might also be necessary. This test
involves insertion of a needle directly into the pelvic bone to withdraw marrow
for examination under the microscope. It is a brief, safe, yet somewhat
uncomfortable, procedure that can help your doctor determine the cause of the anemia.
The most common form of anemia in older adults is "anemia of
chronic disease (or disorder)," also referred to as ACD. With ACD, there is
sufficient iron present in the body, but the bone marrow is unable to
incorporate it into the red blood cells. ACD might be associated with cancer,
chronic renal failure, collagen vascular disease, or a chronic infection.
Another reason for anemia in an older person could be
nutritional deficits that occur when a person loses weight. With significant
weight loss, even when vitamins are administered, the person often develops anemia.
A growing problem often grouped under ACD is suppression of the
bone marrow by medications. Older adults with several chronic illnesses often
require multiple medications. As a matter of fact, 40% of older adults use 5 or
more medications weekly; 12% use 10 or more medications weekly. Some common
medications can suppress the bone marrow, causing anemia. Even if the effect
from any one medication is small, the effect can be enhanced when multiple
medications are given, particularly if there are other problems such as weight
loss as well. Examples of medications that may contribute to anemia include ACE
inhibitors such as lisinopril; ACE receptor blockers such as losartan;
antibiotics such as sulfa-trimethoprim; and certain anticonvulsants.
When the underlying problem is identified and addressed, the
anemia should resolve. Many times, however, the underlying cause might not be
readily apparent. Some doctors offer patients a trial of erythropoietin, or EPO.
EPO is an expensive medicine, available only in injection form, and might not be
covered by your insurance. The government has also issued warnings that EPO may
be associated with problems such as shortened survival in certain types of
cancer, and increased risk of cardiovascular events when used in kidney failure.
The second most common form of anemia is iron deficiency, the
one you are probably most familiar with, since many women have iron deficiency
anemia as young adults from heavy periods or after childbirth. However, older
adults, both men and women, are unlikely to have iron deficiency anemia unless
there is a problem in the intestines, either an absorptive problem, or a loss of
blood in the stool. In this case, tests must be done to discover the source of
bleeding, and the iron must be replaced.
Vitamin B12 deficiency is also a common cause of anemia, and
this condition might be referred to as pernicious anemia. Some people respond to
high doses of oral Vitamin B12 (1000 mcg per day). If the B12 is not absorbed,
then intramuscular injections are given every one to three months, depending
upon the individual requirement. You can learn to do this yourself, or have
someone in your family give you the injections.
Other causes of anemia in older adults include aplastic anemia, myelodysplastic syndrome, folate deficiency, thalassemia, sideroblastic anemia,
and hemolytic anemia. Multiple myeloma might present with anemia, elevated
calcium, and kidney failure.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/1/2009...#8964