More options are available for treating anemia
By DR. V. UPENDER RAO
Published March 12, 2007
The World Health Organization defines anemia as a hemoglobin level of below 13 grams for men and below 12 grams for women. The Women's Health Aging Study followed 667 women age 65 and older for 11 years. The study showed that hemoglobin of below 13 grams was independently associated with increased mortality and disability.
The highest increment in energy resulted from raising the hemoglobin level from 11 grams to 13 grams, suggesting that a hemoglobin level of 13 grams may be optimal in the later years of life.
Contrary to popular perception, anemia is not entirely age-related. Hemoglobin levels are constant throughout all age groups, up to age 90. However, the incidence and prevalence of chronic diseases that can cause anemia do increase with age.
There are many causes of anemia. They include blood loss due to peptic ulcer disease; benign or malignant tumors of the gastrointestinal tract; small bowel diseases; weak and leaky blood vessels; nutritional deficiencies or absorption-related deficiencies of iron, folate and vitamin B12; rheumatoid arthritis; chronic renal failure; other chronic illnesses; and a host of primary bone marrow problems including metastatic carcinoma, myelodysplasia, lymphoma and leukemias.
Consequences of anemia include an increase in all-cause mortality, reduced cognitive function and dementia, increased incidence of congestive heart failure, coronary death, reduced functional capacity and decreased performance status.
Anemic cancer patients are at increased risk of chemotherapy-related toxicity, suboptimal response to chemotherapy and increased need for red cell transfusion.
Investigations usually include simple blood tests, imaging studies, gastrointestinal endoscopy and bone marrow studies. Depending upon the complexity of the case, the bone marrow is subjected to sophisticated procedures such as flow cytometry, cytogenetics and molecular analysis.
Treatment depends on the final diagnosis. Deficiencies of iron, folate and B12 are treated with replacement of these nutrients.
Iron replacement by intravenous infusion works better because of the associated problems of absorption and assimilation in the elderly, especially those who have gastrointestinal pathology, chronic renal failure and those who are undergoing chemotherapy.
Others with chronic renal failure, myelodysplasia and cancer, with or without chemotherapy, will respond well to erythropoietin (Procrit). Congenitally acquired hemoglobin disorders and hemolytic anemias are rarer and treated separately.
In the past, anemia was not treated aggressively because systematic evaluation and diagnosis is cumbersome and due to lack of uniformly effective treatments.
Now, with the availability of Procrit and other erythropoetic agents, chemotherapy and targeted treatments for myelodysplastic anemia, a greater number of patients are realizing the benefits of treatment related increase in hemoglobin levels.
V. Upender Rao, MD, FACP, practices at the Cancer and Blood Disease Center in Lecanto