Even mild anemia has a big impact

Because anemia degrades the ability of the blood to carry oxygen to every cell in the body it has a profound and global affect on function, especially for the brain. Sadly, this is often 'written off' in older folks who miss out on the care they need.Here's a paper published in the journal Haematologica that opens with...

"Mild anemia is a frequent laboratory finding in the elderly usually disregarded in everyday practice as an innocent bystander."

They took over three years to investigate the association of mild anemia with hospitalization and mortality in 7,536 subjects. Here's what their data showed:

"The risk of hospitalization in the 3 years following recruitment was higher among the mildly anemic...Mortality risk in the following 3.5 years was also higher among the mildly anemic elderly...Similar results were found when slightly elevating the lower limit of normal hemoglobin concentration to 12.2 g/dL in women and to 13.2 g/dL in men."

They conclude with this statement:

"After controlling for many potential confounders, mild grade anemia was found to be prospectively associated with clinically relevant outcomes such as increased risk of hospitalization and all-cause mortality."

A study published not long ago in the journal Medicine also highlights the fact that even borderline anemia can have a big effect. First they note:

"The occurrence of anemia in older adults has been associated with adverse outcomes including functional decline, disability, morbidity, and mortality."

In their study...

"Anemia was defined as hemoglobin <13 g/dL for men or <12g/dL for women."

These levels are almost always ignored by most doctors. Here's what their data showed:

"Anemia was associated with greater fatigue, lower handgrip strength, increased number of disabilities, and more depressive symptoms. Multivariate regression analysis...demonstrated strong associations for reduced hemoglobin, even within the "normal" range, and poorer health-related quality of life across multiple domains."

Leading to the conclusion:

"Thus, anemia was independently associated with clinically significant impairments...Mildly low hemoglobin levels, even when above the World Health Organization (WHO) anemia threshold, were associated with significant declines in quality of life among the elderly."

Another paper published in Current Opinion in Hematology begins with the familiar observation:

"Anemia is common in older adults and is an independent predictor for increased morbidity and mortality in several disease states. Older persons with anemia suffer hospitalization, physical decline, and disability at higher rates than those people without anemia."

In their study they found that a third of the cases were due to nutritional deficiencies (!), a third from chronic disease, and a third were unexplained (more on that in a future post). They too found that it predicted diminished physical performance and mobility, and reported the same finding that clarifies how we should understand 'low':

"The data suggest that the risk of mortality and loss of mobility even extends to levels of hemoglobin normally considered low normal by WHO criteria...."

Practitioners take note of their parting comment:

"Anemia is a common modifiable predictor of poor medical outcome in older adults and, as such, should be actively managed."

I'll introduce one more paper published in the Public Library of Science (PLoS One) that focuses on the damage to cognition and mood caused by mild anemia. In this study mood (depression), cognition, attention, memory and quality of life were all quantified for 4,068 individuals. Here's what their data showed:

"In univariate analyses, mild anemic elderly persons had significantly worse results on almost all cognitive, functional, mood, and QoL (Quality of Life) measures. In multivariable logistic regressions...mild anemia remained significantly associated with measures of selective attention and disease-specific QoL."

As in other studies, when the reference range was narrowed to a more precise 'functional' level, the deleterious effect of mild anemia was clear:

"When the lower limit of normal hemoglobin concentration according to WHO criteria was raised to define anemia (+0.2 g/dL), differences between mild anemic and non anemic elderly persons tended to increase on almost every variable."

Here's the bottom line: mild anemia has a profoundly negative impact on every aspect of function and should be investigated diligently as to its cause and treated accordingly.