Diseases frequently associated with anemia in the elderly
| Category and subtypes . | Specific examples . |
|---|---|
| Chronic inflammatory diseases | |
| Rheumatologic diseases | Rheumatoid arthritis, polymyalgia rheumatica |
| Chronic infectious diseases | Chronic hepatitis, osteomyelitis |
| Inflammaging | Frailty, cachexia, geriatric syndromes |
| Miscellaneous | Chronic leg ulcers |
| Nonhematopoietic neoplasms | |
| Gastrointestinal tumors | Colorectal cancer, gastric cancer, etc |
| Multiorgan metastasis | End-stage carcinomas |
| BM metastasis | Various cancer types including breast and prostate |
| Endocrinologic and metabolic causes | |
| Low production of EPO | Renal anemia or pure EPO deficiency* |
| Thyroid dysfunction | Hypothyroidism or hyperthyroidism |
| Insulin deficiency | Diabetes mellitus |
| Blood loss | |
| Gastrointestinal tract bleeding | Peptic ulcer, ulcerative colitis, etc |
| Diffuse GI tract bleeding | Anticoagulant-mediated bleeding |
| Surgical procedures | Multiple abdominal surgeries |
| Different locations | Epistaxis, hematuria |
| Increased consumption or destruction of erythrocytes | |
| Chronic nonmechanical hemolysis | Autoimmune hemolytic anemia |
| Mechanical destruction of red cells | Heart valve–mediated red cell lysis |
| Hypersplenism | Hepato-/splenomegaly |
| Lack of nutrients | |
| Vitamin deficiency | Vitamin B12 and/or folate deficiency |
| Trace element deficiency | Copper deficiency† |
| Iron deficiency | Blood loss |
| Drug-induced anemia | |
| Chemotherapy | Chemotherapy-induced pancytopenia |
| Antimetabolites, anticonvulsants | Folate deficiency |
| Toxic drug reactions | Drug-induced hemolysis |
| Category and subtypes . | Specific examples . |
|---|---|
| Chronic inflammatory diseases | |
| Rheumatologic diseases | Rheumatoid arthritis, polymyalgia rheumatica |
| Chronic infectious diseases | Chronic hepatitis, osteomyelitis |
| Inflammaging | Frailty, cachexia, geriatric syndromes |
| Miscellaneous | Chronic leg ulcers |
| Nonhematopoietic neoplasms | |
| Gastrointestinal tumors | Colorectal cancer, gastric cancer, etc |
| Multiorgan metastasis | End-stage carcinomas |
| BM metastasis | Various cancer types including breast and prostate |
| Endocrinologic and metabolic causes | |
| Low production of EPO | Renal anemia or pure EPO deficiency* |
| Thyroid dysfunction | Hypothyroidism or hyperthyroidism |
| Insulin deficiency | Diabetes mellitus |
| Blood loss | |
| Gastrointestinal tract bleeding | Peptic ulcer, ulcerative colitis, etc |
| Diffuse GI tract bleeding | Anticoagulant-mediated bleeding |
| Surgical procedures | Multiple abdominal surgeries |
| Different locations | Epistaxis, hematuria |
| Increased consumption or destruction of erythrocytes | |
| Chronic nonmechanical hemolysis | Autoimmune hemolytic anemia |
| Mechanical destruction of red cells | Heart valve–mediated red cell lysis |
| Hypersplenism | Hepato-/splenomegaly |
| Lack of nutrients | |
| Vitamin deficiency | Vitamin B12 and/or folate deficiency |
| Trace element deficiency | Copper deficiency† |
| Iron deficiency | Blood loss |
| Drug-induced anemia | |
| Chemotherapy | Chemotherapy-induced pancytopenia |
| Antimetabolites, anticonvulsants | Folate deficiency |
| Toxic drug reactions | Drug-induced hemolysis |
Typical and more common causes of anemia in the elderly are listed. Many more underlying disorders may be identified. In addition, in many elderly individuals, >1 disease is present and may substantially aggravate the anemia.
Insufficiently low EPO production in response to anemia is typically seen in patients with CKD but is sometimes also seen in elderly patients without impaired excretory renal function. This pure form of impaired EPO production is typically seen in elderly patients with mild anemia and may be an underestimated cause of anemia at older age or ICUS-A.
Copper deficiency may be associated with marked BM dysplasia and may even mimic MDS.