Anemia Workup Completion Rates Among Elderly Patients in a Tertiary Center in the Middle East
Authors: Hodroj Mohammad Hassan , Klim Joseph , Akiki Nathalie , Taher Ali T. 
Published: December 2024

Anemia Workup Completion Rates Among Elderly Patients in a Tertiary Center in the Middle East

Background:

Among elderly individuals, anemia is a prevalent condition that can lead to significant health implications and should not be considered as a result of physiological aging. Age-related factors, chronic illnesses, and nutritional deficiencies contribute to the increased vulnerability of older adults to develop anemia. Anemia in elderly has been always linked to numerous complications and even mortality. Timely and comprehensive anemia workup is essential to identify and address the underlying causes effectively. This abstract investigates the completion rates of anemia workup among elderly patients in a tertiary center in the Middle East, which reflects the awareness extent regarding the importance of working up and treating anemia in elderly population.

Methods:

We conducted a retrospective study involving elderly patients 65 years old and older admitted to the inpatient service under the care of any department and diagnosed with anemia between November 2018 and March 2021 at the American University of Beirut Medical Center in Lebanon. 1500 electronic charts of elderly patients admitted to the hospital were reviewed after the IRB approval and data was collected accordingly including age, gender, hemoglobin level, mean corpuscular volume, nationality, type of anemia, workup rate, management rate and the admitting divisions. Patients with hematological or oncological malignancies together with patients with hemolytic disorders were excluded from the study.

In this study, we assessed the rate of anemia among admitted elderly patients, the type of anemia and the rate of anemia workup completion based laboratory investigations and diagnostic tests recommended by guidelines among different admitting divisions.

Results:

Out of 1500 charts that were reviewed, 1143 patients were included after excluding 357 charts. The cohort included 813 males (54.2%) and 687 females (45.8%) with a median age of 77 ± 7.62 and 95% were Lebanese. 653 patients (57.23%) were diagnosed with anemia and its types were distributed as 91 (13.93%) microcytic, 532 (81.77%) normocytic and 28 (4.28%) macrocytic. Among the diagnosed patients, only 101 (15.46%) completed an anemia workup, while in 552 (84.54%) anemia and its causes were not investigated. In addition, only 136 patients out of the 653 (20.8%) received any type of management not limited to iron supplementation, vitamin B12 supplementation, folate supplementation or blood transfusion. Regarding the admitting divisions from different departments, the percentage of working up anemia in elderly was distributed as the following: 6.66% in neurosurgery, 6.91% in cardiology, 9.1% in orthopedics, 9.52% in neurology, 12.12% in vascular surgery, 17.6% in general surgery, 20% in geriatric, 20% in rheumatology, 25% in urology, 26.1% in pulmonology, 37.5% in infectious diseases, 40.9% in nephrology, 41.6% in gastroenterology and 64.28% in family medicine.

Discussion:

Our study showed a prevalence of anemia of 57.23% among admitted elderly patients which fits in the prevalence range reported by several studies that showed a prevalence of 43.9% to 71.0% and the most common type of anemia was normocytic similar to other studies that focused on this specific population. The results showed a discrepancy between different internal medicine divisions with percentages ranging between as low as 6.91% to above 40% in other divisions. In addition, the majority of surgical divisions had low percentages of workup that did not exceed 26.1%, which can compromise the care of many patients who are admitted for surgical interventions and can increase the risks of morbidity and mortality.

Conclusion:

In conclusion, this study highlights a trend of low anemia workup among elderly patients in a tertiary center in the Middle East. This should highlight the importance of performing a full anemia workup in elderly patients in order to diagnose their anemias as early as possible and manage accordingly to improve their clinical outcome and quality of life. Trainings and workshops involving physicians from all divisions should be held to expand the knowledge and provide the basic experience to deal with anemia, order the initial workup when encountering any elderly patient with any type of anemia.