Ask The Expert: Question Archive

Question:
Do you have any recommendations for evaluation or treatment of an elderly woman (83 years of age) with chronic, severe anemia that requires a blood transfusion every 12-18 months to reinstate hemoglobin status? There has been no evidence of gastrointestinal bleeding from an endoscopy/colonoscopy, her dietary intake is excellent, and prophylactic iron supplementation has not prevented the decline in hemoglobin level. Her kidney function is estimated at 33 ml/minute.

NAAC Expert Response:
It is always important to perform a thorough anemia evaluation as older adults may have more than one reason for anemia. Important causes to exclude, in addition to iron deficiency and bleeding, are vitamin B12 and folate deficiencies, a chronic inflammatory disease, or a bone marrow disorder. In the case described, the anemia may relate to chronic kidney disease as is evidenced by the estimated glomerular filtration rate of only 33 ml/minute. Referral to a nephrologist to discuss the risks and benefits of erythropoiesis-stimulating agents should be considered.

Last Updated: October 27, 2009