Main Article Content

. Maria Luigia Randi
Prof. Fabrizio Fabris


Anemia, Elderly, Hospitalized old patient


In the western countries about half of the hospitalized patients are anemic. Generally, these patients are old, often with multiple diseases and anemia worsens the prognosis finally increasing the risk of death. We describe here a monocentric, observational study that evaluates 249 consecutive adult patients (160 women and 89 men) with anemia admitted in the internal medicine department over 5 months period. They represent 71.5% of all patients admitted in the study period. Demographic, historic and clinical data, laboratory tests, duration of hospitalization, re-admission at 30 days and death were recorded. Patients were stratified by age (75-84= old, >85 years= oldest-old), anemia severity, and etiology of anemia.

In 37 old and 25 oldest-old patients anemia was mild, in 43 old and 46 oldest-old moderate and in 20 old and 7 oldest-old severe in agreement with WHO criteria. Moderate anemia was significantly more common in oldest-old (p=0.01)

The causes of anemia were iron deficiency in 19 patients, other deficiencies in 5, chronic diseases in 68, hematologic neoplasms in 11, multifactorial in 43 and undetermined in 32. Oldest-old have higher frequency of multifactorial anemia (p=0.04) while hematologic neoplasms were more common in old patients (p=0.03). Most patients with undetermined anemia had mild/moderate forms.An anti-anemic treatment, mainly blood transfusion, was adopted in 100% of oldest-old patients and in 60% of old (p= 0.04). Anemia (and/or its treatment) was reported in the discharge letter in 19 old and in 22 oldest old patients.

From a general point of view, physicians seem to disregard anemia, in the context of more important pathologic conditions. In oldest-old patients, multifactorial anemia seems to be consider only “one more cause of disability”. When a border line anemia occurs, even if it can represent a relevant adverse condition in frailty, is poorly considered. 




Download data is not yet available.
Abstract 53 | PDF Downloads 21 HTML Downloads 13


1-WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and
Mineral Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1)
2- Gaskell H, Derry S, Andrew Moore R, Mc Quay HJ: Prevalence of anemia in older persons: systematic review. BMC Geriatr. 2008;8:1-8
3- Girelli D, Marchi G, Camaschella C: Anemia in the elderly. Hemasphere 2018;2: e40.doi: 10.1097/HS9.0000000000000040
4-Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood 2006;107:1747-50
5- Kassebaum NJ: The global burden of anemia. Hematol Oncol Clin North Am 2016;30:247-08
6- Cleland JGF, Zhang J. Pellicori PP, Dicken B, Dierckx R, Shoaib A, Wong K, Rigby A, Goode K, Clark AL. Prevalence and outcome of anemia and hematinic deficiencies in patients with chronic heart failure. JAMA Cardiol 2016;1:539-47
7- Farhan S, Baber U, Mehran R: Anemia and acute coronary syndrome: time for intervention studies. J Am Heart Assoc 2016:19;5:e004908. doi: 10.1161/JAHA.116.004908.
8- Barlas RS, Honney K, Loke YK, McCall SJ, Bettencourt?Silva JH, Clark AB, Bowles KM, Metcalf AK, Mamas MA, Potter JF, Myint PK. Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta?Analysis. J Am Heart Assoc. 2016;5: e003019. doi: 10.1161/JAHA.115.003019.
9- Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood, 2004; 104: 2263-8.
10- Migone De Amicis M, Chivite D, Corbella X, Cappellini MD, Formiga F. Anemia is a mortality prognostic factor in patients initially hospitalized for acute heart failure. Intern Emerg Med 2017;12:749-56
11- Tettamanti M, Lucca U, Gandini F, Recchia A, Mosconi P, Apolone G, Nobili A, Tallone MV, Detoma P, Giacomin A, Clerico M, Tempia P, Savoia L, Fasolo G, Ponchio L, Della Porta MG, Riva E. Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study. Haematologica, 2010; 95:1849-56.
12- Andrès E, Serraj K, Federici L, Vogel T, Kaltenbach G. Anemia in elderly patients: new insight into an old disorder. Geriatr Gerontol Int, 2013; 13: 519-27.
13- Cascio MJ, De Loughery TG. Anemia: Evaluation and Diagnostic Tests. Med Clin North Am, 2017; 101: 263-84.
14- Randi ML, Bertozzi I, Santarossa C, Cosi E, Lucente F, Bogoni G, Biagetti G, Fabris F: Prevalence and causes of anemia in hospitalized patients: impact on diseases outcome. J Clin Med 2020; 9:950, doi:10.3390/jcm9040950
15- Von Humboldt S, Leal I. The Old and the Oldest-old: Do They Have Different Perspectives on Adjustment to Aging? Intern J of Gerontology. 2015;9:156-60
16- Royal College of Physicians: National Early Warning Score (NEWS): standardizing the assessment of acute-illness severity in the NHS. London 2012, RCP
17- Engert A, Balduini C, Brand A, Coiffier B, Cordonnier C, Döhner H, de Wit TD, Eichinger S, Fibbe W, Green T, de Haas F, Iolascon A, Jaffredo T, Rodeghiero F, Salles G, Schuringa JJ. The European Hematology Association Roadmap for European Hematology Research: a consensus document. Haematologica. 2016;101:115-208.
18- Buurman BM, Hoogerduijn JG, van Gemert EA, de Haan RJ, Schuurmans MJ, de Rooij SE. Clinical characteristics and outcomes of hospitalized older patients with distinct risk profiles for functional decline: a prospective cohort study. PLoS One. 2012;7:e29621. doi: 10.1371/journal.pone.0029621
19- Zilinski J, Zillmann R, Becker I, Benzing T, Schulz RJ, Roehrig G: Prevalence of anemia among elderly inpatients and its association with multidimensional loss of function. Ann Hematol 2014;93:1645-54
20- Nathavitharana RL, Murray JA, D’Sousa N, Sheehan T, Frampton CM, Baker BW. Anemia in highly prevalent among unselected internal medicine inpatients and is associated with increased mortality, early readmission and more prolonged hospital stay. An observational retrospective cohort study. Int Med J 2012;42:683-91
21- Zaninetti C, Klercy C, Scaravello C, Bastia R, Baduini CL, Invernizzi R: Prevalence of anemia in hospitalized internal medicine patients: correlation with comorbidities and length of hospital stay. Eur J Intern Med 2018;51:11-7
22-Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management.
Blood 2018;1;131:505-14.
23 - Weiss G, Goodnough LT. Anemia of Chronic Disease. N Engl J Med. 2005;352:1011-23.
24-Radovanovic D, Sotgiu G, Jankovic M, Mahesh PA, Marcos PJ, Abdalla MI, Di Pasquale MF, Gramegna A, Terraneo S, Blasi F, Santus P, Aliberti S, Reyes LF, Restrepo MI. GLIMP Study Group. Eur J Intern Med. 2019;60:54-70.
25- Camaschella C. New insights into iron deficiency and iron deficiency anemia. Blood Rev 2017;31:225-33
26- De Franceschi L, Iolascon A, Taher A, Cappellini MD Clinical management of iron deficiency anemia in adults: Systemic review on advances in diagnosis and treatment. Eur J Intern Med. 2017;42:16-23.
27- Madu AJ, Ughasoro MD. Anaemia of Chronic Disease: An In-Depth Review. Med Princ Pract. 2017;26:1-9.
28- Lam CSP, Doehner W, Comin-Colet J. IRON CORE Group. Iron deficiency in chronic heart failure: case-based practical guidance. ESC Heart Fail. 2018;5:764-71.