Iron deficiency anemia and anemia of chronic disease in geriatric hospitalized patients: How frequent are comorbidities as an additional explanation for the anemia?

Aim: Anemia is an important clinical problem in older patients. The aim of the present study was to investigate whether comorbidities as an additional explanation for the severity of the anemia are frequent, and might help to explain the anemia severity in older patients with iron deficiency anemia (IDA) and the anemia of chronic disease (ACD).

Methods: In the present prospective study, 191 consecutive hospitalized older patients with IDA and the ACD were investigated. A peripheral blood count, C-reactive protein, standard iron parameters, serum vitamin B12 and folate, and renal and thyroidal function tests were analyzed. The attending geriatrician was responsible for the medical diagnosis and follow up.

Results: A total of 56 patients with IDA and 135 with the ACD were investigated. Just 24 patients with IDA had normal serum folate, vitamin B12 and thyroid-stimulating hormone levels without laboratory evidence of inflammation or chronic renal failure, but one of these patients was diagnosed with hemolytic anemia. Hence, 23 patients (41%) were diagnosed with "IDA only". "ACD only" was diagnosed in 104 patients (77%), and 22 patients (16%) with ACD had chronic renal failure. A myelodysplastic syndrome was found in two patients.

Conclusions: Additional etiologies are often diagnosed in anemic older patients, but it remains unknown to what extent these diseases might influence the pathogenesis of the anemia. Individual and clinical judgment remain crucial to evaluating and treating older anemic patients.