Causes of Anemia
- Diagnosing the root cause of anemia can be difficult, and the workup is often complicated by comorbidities that mask the underlying etiologyAlvarez-Payares JC et al. Cureus. 2021;13:e19971.
- Anemia is frequently detected incidentally in routine peripheral blood tests, and some patients may remain asymptomatic and unrecognized for monthsKhan AM. Am J Med. 2012;125(suppl):S15-17.
- When the cause of anemia is uncertain based on the patient’s history and physical examination, a thorough assessment is necessary to identify its underlying origin, primarily relying on a diagnosis by exclusionGoodnough LT, Schrier SL. Am J Hematol. 2014;89:88-96. Guralnik J et al. J Am Geriatr Soc. 2022;70:891-899.
Possible causes of anemia in older patientsAlvarez-Payares JC et al. Cureus. 2021;13:e19971. Stauder R et al. Blood. 2018;131:505-514. Girelli D et al. Hemasphere. 2018;2:e40.
Nutritional deficiency
- Iron deficiency
- Vitamin B12 deficiency
- Folate deficiency
- Vitamin D deficiency
Inflammatory/chronic disease
- Chronic kidney disease
- Autoimmune/rheumatologic disease
- Cancer
- Chronic infection
Clonal hematopoiesis
- Myelodysplastic syndromes (MDS)
- Clonal hematopoiesis of
indeterminate potential (CHIP) - Clonal cytopenia of
undetermined significance (CCUS) - Acute myeloid leukemia (AML)
Others
- Drug-induced causes
- Endocrine/metabolic causes
- Blood loss (eg, gastrointestinal bleeding)
- Hemolysis
cases of anemia in older patients is unexplainedGuralnik J et al. J Am Geriatr Soc. 2022;70:891-899. Stauder R et al. Blood. 2018;131:505-514. Girelli D et al. Hemasphere. 2018;2:e40.
Some cases are associated with an increased risk of hematologic malignancies, which should trigger suspicion of underlying MDS, especially with the following:
High mean corpuscular volume
Peripheral blood dysplasia
Presence of blasts
Clonal hematopoiesis
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Diagnosing MDS requires an extensive series of tests, but it is also important to have a high clinical suspicion to identify risk factors for developing MDS, such as advancing ageHasserjian RP et al. Blood. 2023;142:2247-2257. Sekeres MA. Hematol Oncol Clin North Am. 2010;24:287-294.
