BIOGRAPHY
General medicine and Haematology advanced trainee from Christchurch Hospital. ABSTRACT
Anaemia in the elderly: a single centre retrospective analysis of inpatient vs outpatient investigation of a common problem. Vidya Mathavan1
Peter Ganly2
1 – General medicine and Haematology advanced trainee, Canterbury district health board.
2 – Haematologist, Canterbury district health board.
Background
Anaemia is associated with higher incidence of cognitive impairment, cardiovascular disease, falls, decreased quality of life and reduced life expectancy in the elderly (1,2,3,4). 30% of anaemic elderly have unexplained anaemia (UA), a proportion of these likely to be undiagnosed myelodysplastic syndrome (MDS) (1, 2, 3, 4). Some low risk MDS patients can be treated with Erythropoietin. High risk MDS patients maybe candidates for the drug Azacitadine.
Method
Records of 100 consecutive general medical inpatients aged above 75 at Christchurch hospital were reviewed. 39 were anaemic without significant other cytopenias (platelets <100 or neutrophils <1.0). 3 had acute bleeding. Clinical details of the remaining 36 were compared to 36 consecutive outpatients referred to haematology with anaemia.
Results
Mean age between outpatients and inpatients was similar (83.9 vs 84.9). Outpatients had lower haemoglobins (mean 90 vs 104; p=0.0001) and higher incidence of macrocytosis (42% vs 15%). Of the inpatients 19(53%) had iron studies, 18 (50%) B12/folate levels and 3 had laboratory myeloma screens (8%) within 12 months of their admission. None had a full haemolysis screen. All outpatients had a full laboratory workup. Patients with an eGFR of less than 30 were similar (3 vs 4)
24/36(66.6%) outpatients had bone marrow biopsies, all given a diagnosis (MDS in 14(58%). Of the remaining 12, 10 were given a diagnosis, 2 were labelled as UA.
5/36 inpatients had had bone marrow biopsies with pre-existing diagnoses. 9 had significant dependency, cognitive impairment and/or a metastatic malignancy. 1 of the remaining 22 had a bone marrow biopsy. Anaemia was not mentioned in the discharge summary of 26/35(74%) inpatients (1 died); 30/35(85%) did not receive a diagnosis.
Conclusions
Elderly anaemic outpatients are more likely to have comprehensive laboratory investigations and a bone marrow biopsy. Reasons for this include more severe anaemia, higher incidence of macrocytosis and outpatients being biologically younger. Irrespective of the investigations performed, outpatients were more likely to receive a diagnosis for their anaemia which could have both treatment and prognostic implications.
References
1) Stauder, R et al. Anaemia in the elderly: clinical implications and new therapeutic concepts. Haematologica 2014; 99(7) 1127-1129
2) Vanasse, G et al. Anaemia in the elderly patients: an emerging problem for the 21st century. American society of Haematology 2010; 271-275.
3) Guralnik, J et al. Anaemia in the Elderly: A public Health Crisis in Haematology. American Society of Haematology 2005; 528-532
4) Patel, Kushang. Epidemiology of Anaemia in older adults. Seminars in Haematology.2008; 45:210-217.
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