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Anemia in the Elderly: Types to Treatments

Oct. 2, 2018

Anemia among the elderly is common. Most likely some of your residents are currently living with this condition. Residents with an anemia diagnosis have a lower than normal amount of red blood cells, or the hemoglobin in their red blood cells falls below normal. When the red blood cell count is low, the body’s cells do not get sufficient oxygen. Let’s take a closer look at the types of anemia, the symptoms, common bloodwork and the types of treatment available.

Understanding the Type of Anemia in Seniors

It is helpful for all LTC professionals to be aware of the different types of anemia. Variations include:

  • Iron deficient
  • B12 deficient (primarily geriatric residents)
  • Folic Acid Deficient

Common types of anemia in LTC residents

While not inevitable, anemia prevalence does increase with age. Some age-related physical changes increase anemia risk for seniors. Older adults are susceptible to decreased hematopoietic tissue in bone marrow and low iron utilization. Decreasing erythropoietin levels also impact anemia risk as we age. Erythropoietin levels can fall due to renal dysfunction, low oxygen or decreased testosterone. 

When it comes to anemia in the elderly there are several common causes: chronic disease, medication (Metformin and Proton Pump Inhibitors), iron deficiency, B12 deficiency, folate deficiency, gastrointestinal bleeding, bariatric surgery and myelodysplastic syndrome. These causes may indicate other underlying health problems. For example, iron deficiency-related anemia indicates potential absorptive problems in the intestines or loss of blood in the stool. Additionally, some chronic conditions can interfere with the body’s ability to produce red blood cells. Diseases like cancer, Crohn’s disease and other inflammatory conditions, HIV/AIDS, rheumatoid arthritis and kidney disease can lead to anemia.  For this reason, anemia is often a disease indicator, and for 80 percent of older adults with anemia, an underlying cause is identified.

Symptoms of anemia in older adults to watch for

There are several signs and symptoms long-term care professionals can watch for to identify potentially anemic residents.

Symptoms of acute anemia may include:

  • Tachycardia (rapid heartbeat)
  • Tight headedness
  • Shortness of breath
  • Lethargy

Symptoms of chronic anemia may include:

  • Headache
  • Weakness
  • Vertigo
  • Faintness
  • Pale skin

Bloodwork and treatments commonly performed for anemia

Bloodwork and iron labs are taken for diagnosis and cause-identification purposes.  Best-fit treatment options are selected based on diagnosis and cause-identification.

Blood work for anemia diagnosis

Anemia in older adults is commonly diagnosed with standard bloodwork. Here’s what to look for in your resident’s blood work:

HGB – a value less than the normal range is considered anemia.

  • Male range 13.5 – 17.5 g/dL
  • Female range 12 – 15.5 g/dL

HCT – a measure of the percentage of blood volume made up by RBCs.

  • Male range 38 – 50%
  • Female range 35 – 46%

Serum Iron – amount of circulating iron bound to transferrin.

  • Male range 55 – 160 mcg/dL
  • Female range 40 – 155 mcg/dL

Total iron binding capacity (TIBC)

  • Normal range is 20 – 40%

Transferring saturation (Tsat)

  • Serum iron/TIBC x 100%
  • 25 – 35%

Ferritin – measurement of iron stored in the body

  • Male range 20 – 500ng/mL
  • Female range 20 – 200ng/mL

Mean corpuscular volume (MCV) – the average volume of red blood cells.

  • Adult range 80 – 96 fL/cell

Mean corpuscular hemoglobin (MCH) – the average amount of hemoglobin inside a RBC.

  • Adult range 27 – 33pg/cell

Mean corpuscular hemoglobin concentration (MCHC) – the average concentration of hemoglobin inside a RBC.

  • Adult range 33 - 36g/dL

Treatment of anemia in older adults

Treatments vary widely based on anemia type and severity. Caring for seniors struggling with may include therapies ranging from relatively simple supplementation and dietary awareness, to more complex approaches. Here are some of the common anemia treatments:

  • Iron supplementation
    • Ferrous sulfate
    • Ferrous gluconate
    • Ferrous fumarate
    • Polysaccharide iron
    • Iron supplementation note: If patient cannot tolerate ferrous sulfate due to adverse GI effects, ferrous gluconate is often better tolerated although not absorbed as well.  
  • B12 supplementation
  • Folate supplementation
  • Dietary considerations
    • Seafood
    • Red meats
    • Beans and whole grains
    • Vegetables
  • Blood transfusion
  • Treatment of underlying cause or condition

Help residents increase supplement effectiveness with the following education:

  1. Antacids or calcium should not be ingested within four hours of iron supplements.
  2. Iron supplements are best taken on an empty stomach, if tolerated.
  3. Taking Vitamin C with iron may increase absorption rate.

HealthDirect: Your trusted anemia care partner

Have questions or want more information about best practices and treatments for seniors with anemia? Connect with your HealthDirect pharmacist consultant by completing the quick form below.  

Understanding Anemia in the Elderly: From Types to Treatments

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References:

Nakia Duncan. “True Blood: Clinical Considerations in the Management of Anemia.” ASCP Webinars, file:///Users/melissa/Downloads/ASCP_Anemia_Duncan_final_pdf_62018%20(1).pdf.

“Patients.” Blood Clots, 1 June 2018, www.hematology.org/patients.

“About Chronic Kidney Disease.” The National Kidney Foundation, 28 Mar. 2018, www.kidney.org/atoz/content/about-chronic-kidney-disease.

 “Anemia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 8 Aug. 2017, www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360.

Brandi VanValkenburg

Brandi provides personalized care as a pharmacy consultant with HealthDirect's northeastern region.  She's been serving our clients for nearly 10 years. 

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