Query: Anemia

title: [Anemia of chronic disease]
abstract: Anemi ved kronisk sykdom er i Vesten den vanligste formen for anemi hos hospitaliserte pasienter over 50 ar. Diagnostikken kompliseres av at de klassiske biokjemiske parametrene, brukt til vurdering av jernstatus, pavirkes av immunaktiveringen som er forarsaket av grunnsykdommen.

title: Anemia at older age: etiologies, clinical implications, and management.
abstract: Anemia is quite frequently diagnosed in older individuals and is a key indicator of various reactive and clonal conditions. Many underlying diseases, like myelodysplastic syndrome (MDS) develop preferentially in elderly individuals. The prevalence of anemia at older age is increasing, and this is mainly attributable to more frequently applied diagnostics and demographic changes in our societies. The etiology of anemia at older age is complex and ranges from bone marrow failure syndromes to chronic kidney disease, and from nutritional deficiencies to inflammatory processes including inflammaging in immunosenescence. In a smaller number of cases, no clear cut etiology is identified. These patients are referred to as unexplained anemia or idiopathic cytopenia of unknown significance. In others, somatic mutations in leukocytes are found, but diagnostic criteria for MDS or other hematologic diseases are not fulfilled, a condition termed clonal cytopenia of undetermined significance. Management of anemias at older age depends on (1) the severity of the anemia, (2) underlying condition(s) and (3) patient related factors, including comorbidities. Even a mild anemia may substantially affect physical and cognitive capacities and quality of life. An underestimated aspect is that because of age related changes, organ function such as erythropoietin production in the kidney may become suboptimal. Management and treatment of anemia in older patients often require a multidisciplinary approach and detailed investigations of organ function. In this article, we review current concepts around anemias at older age, with special emphasis on etiologies, clinical implications, and innovative concepts in the management of these patients.

title: How I treat acquired aplastic anemia.
abstract: Acquired severe aplastic anemia (SAA) is a rare hematologic disease associated with significant morbidity and mortality. Immune destruction of hemopoietic stem cells plays an important role in pathogenesis, as shown by successful treatment with immunosuppressive agents, leading to transfusion independence or complete recovery of peripheral blood counts in a proportion of patients. Growth factors can be combined with immunosuppressive therapy (IST) and may improve response rates, as recently shown with thrombopoietin analogs. Anabolic steroids may still play a role in combination with IST. The problem with IST is failure to respond and the development of late clonal disorders. Bone marrow transplantation (BMT) is the other therapeutic option: a matched sibling donor remains the best choice. For patients lacking a matched family donor, unrelated donors can be readily found, although mostly for patients of Caucasian origin. Other BMT options include unrelated cord blood or mismatched family donors. Acute and chronic graft versus host disease remain important complications of BMT. Patient age is a strong predictor of outcome for both IST and BMT, and must be considered when designing therapeutic strategies. Early diagnosis and treatment, as well as long term monitoring, remain crucial steps for successful treatment of SAA.

title: A systematic analysis of global anemia burden from 1990 to 2010.
abstract: Previous studies of anemia epidemiology have been geographically limited with little detail about severity or etiology. Using publicly available data, we estimated mild, moderate, and severe anemia from 1990 to 2010 for 187 countries, both sexes, and 20 age groups. We then performed cause specific attribution to 17 conditions using data from the Global Burden of Diseases, Injuries and Risk Factors (GBD) 2010 Study. Global anemia prevalence in 2010 was 32.9% causing 68.36 (95% uncertainty interval [UI] 40.98 to 107.54) million years lived with disability (8.8% of total for all conditions [95% UI, 6.3% to 11.7% Prevalence dropped for both sexes from 1990 to 2010, although more for males. Prevalence in females was higher in most regions and age groups. South Asia and Central, West, and East sub Saharan Africa had the highest burden, while East, Southeast, and South Asia saw the greatest reductions. Iron deficiency anemia was the top cause globally, although 10 different conditions were among the top 3 in regional rankings. Malaria, schistosomiasis, and chronic kidney disease related anemia were the only conditions to increase in prevalence. Hemoglobinopathies made significant contributions in most populations. Burden was highest in children under age 5, the only age groups with negative trends from 1990 to 2010.

title: Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial
abstract: Importance In one third of older men with anemia, no recognized cause can be found.  To determine if testosterone treatment of men 65 years or older with unequivocally low testosterone levels and unexplained anemia would increase their hemoglobin concentration.  A double blinded, placebo controlled trial with treatment allocation by minimization using 788 men 65 years or older who have average testosterone levels of less than 275 ng/dL. Of 788 participants, 126 were anemic (hemoglobin 12.7 g/dL) 62 of whom had no known cause. The trial was conducted in 12 academic medical centers in the United States from June 2010 to June 2014.  Testosterone gel, the dose adjusted to maintain the testosterone levels normal for young men, or placebo gel for 12 months.  The percent of men with unexplained anemia whose hemoglobin levels increased by 1.0 g/dL or more in response to testosterone compared with placebo. The statistical analysis was intent to treat by a logistic mixed effects model adjusted for balancing factors.  The men had a mean age of 74.8 years and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 30.7; 84.9% were white. Testosterone treatment resulted in a greater percentage of men with unexplained anemia whose month 12 hemoglobin levels had increased by 1.0 g/dL or more over baseline (54% than did placebo (15% (adjusted OR, 31.5; 95% CI, 3.7 277.8; P .002) and a greater percentage of men who at month 12 were no longer anemic (58.3% compared with placebo (22.2% (adjusted OR, 17.0; 95% CI, 2.8 104.0; P .002) Testosterone treatment also resulted in a greater percentage of men with anemia of known cause whose month 12 hemoglobin levels had increased by 1.0 g/dL or more (52% than did placebo (19% (adjusted OR, 8.2; 95% CI, 2.1 31.9; P .003) Testosterone treatment resulted in a hemoglobin concentration of more than 17.5 g/dL in 6 men who had not been anemic at baseline.  Among older men with low testosterone levels, testosterone treatment significantly increased the hemoglobin levels of those with unexplained anemia as well as those with anemia from known causes. These increases may be of clinical value, as suggested by the magnitude of the changes and the correction of anemia in most men, but the overall health benefits remain to be established. Measurement of testosterone levels might be considered in men 65 years or older who have unexplained anemia and symptoms of low testosterone levels.

title: Iron deficiency anemia
abstract: Iron deficiency, defined as the absence of iron stored in the reticuloendothelial system, is the most common nutritional disorder, affecting 30 70% of the population of less developed countries but less than 20% of the population in the industrialized world. It is particularly prevalent in women of childbearing age and in children. If iron intake does not provide sufficient iron to maintain adequate production of red blood cells (RBCs) iron deficiency leads to iron deficiency anemia (IDA) IDA is the most common anemia syndrome encountered in clinical medicine. In a recent review of healthy individuals in the US military, IDA had an incidence of 3.4 per 10,000 patient years in men but 29.5 per 10,000 patient years in women.

title: The Global Burden of Anemia.
abstract: Anemia is an important cause of health loss. We estimated levels and trends of nonfatal anemia burden for 23 distinct etiologies in 188 countries, 20 age groups, and both sexes from 1990 to 2013. All available population level anemia data were collected and standardized. We estimated mean hemoglobin, prevalence of anemia by severity, quantitative disability owing to anemia, and underlying etiology for each population using the approach of the Global Burden of Disease, Injuries and Risk Factors 2013 Study. Anemia burden is high. Developing countries account for 89% of all anemia related disability. Iron deficiency anemia remains the dominant cause of anemia.

title: Maternal anemia and risk of adverse birth and health outcomes in low and middle income countries: systematic review and meta analysis.
abstract: Anemia is a leading cause of maternal deaths and adverse pregnancy outcomes in developing countries.  We conducted a systematic review and meta analysis to estimate the pooled prevalence of anemia, the association between maternal anemia and pregnancy outcomes, and the population attributable fraction (PAF) of these outcomes that are due to anemia in low and middle income countries.  PubMed, EMBASE, CINAHL, and the British Nursing Index were searched from inception to May 2015 to identify cohort studies of the association between maternal anemia and pregnancy outcomes. The anemic group was defined as having hemoglobin concentrations <10 or <11 g/dL or hematocrit values <33% or <34% depending on the study. A metaregression and stratified analysis were performed to assess the effects of study and participant characteristics on adverse pregnancy risk. The pooled prevalence of anemia in pregnant women by region and country income category was calculated with the use of a random effects meta analysis.  Of 8182 articles reviewed, 29 studies were included in the systematic review, and 26 studies were included in the meta analysis. Overall, 42.7% (95% CI: 37.0% 48.4% of women experienced anemia during pregnancy in low and middle income countries. There were significantly higher risks of low birth weight (RR: 1.31; 95% CI: 1.13, 1.51) preterm birth (RR: 1.63; 95% CI: 1.33, 2.01) perinatal mortality (RR: 1.51; 95% CI: 1.30, 1.76) and neonatal mortality (RR: 2.72; 95% CI: 1.19, 6.25) in pregnant women with anemia. South Asian, African, and low income countries had a higher pooled anemia prevalence than did other Asian and upper middle income countries. Overall, in low and middle income countries, 12% of low birth weight, 19% of preterm births, and 18% of perinatal mortality were attributable to maternal anemia. The proportion of adverse pregnancy outcomes attributable to anemia was higher in low income countries and in the South Asian region.  Maternal anemia remains a significant health problem in low and middle income countries.

title: Severe anemia in Malawian children.
abstract: Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied.  We conducted a case control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool children without severe anemia in urban and rural settings in Malawi. Causal factors previously associated with severe anemia were studied. The data were examined by multivariate analysis and structural equation modeling.  Bacteremia (adjusted odds ratio, 5.3; 95% confidence interval [CI] 2.6 to 10.9) malaria (adjusted odds ratio, 2.3; 95% CI, 1.6 to 3.3) hookworm (adjusted odds ratio, 4.8; 95% CI, 2.0 to 11.8) human immunodeficiency virus infection (adjusted odds ratio, 2.0; 95% CI, 1.0 to 3.8) the G6PD 202/ 376 genetic disorder (adjusted odds ratio, 2.4; 95% CI, 1.3 to 4.4) vitamin A deficiency (adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.8) and vitamin B12 deficiency (adjusted odds ratio, 2.2; 95% CI, 1.4 to 3.6) were associated with severe anemia. Folate deficiency, sickle cell disease, and laboratory signs of an abnormal inflammatory response were uncommon. Iron deficiency was not prevalent in case patients (adjusted odds ratio, 0.37; 95% CI, 0.22 to 0.60) and was negatively associated with bacteremia. Malaria was associated with severe anemia in the urban site (with seasonal transmission) but not in the rural site (where malaria was holoendemic) Seventy six percent of hookworm infections were found in children under 2 years of age.  There are multiple causes of severe anemia in Malawian preschool children, but folate and iron deficiencies are not prominent among them. Even in the presence of malaria parasites, additional or alternative causes of severe anemia should be considered.

title: Anemia of Inflammation: A Review.
abstract: Impaired iron homeostasis and the suppressive effects of proinflammatory cytokines on erythropoiesis, together with alterations of the erythrocyte membrane that impair its survival, cause anemia of inflammation. Recent epidemiologic studies have connected inflammatory anemia with critical illness, obesity, aging, kidney failure, cancer, chronic infection, and autoimmune disease. The proinflammatory cytokine, interleukin 6, the iron regulatory hormone, hepcidin, and the iron exporter, ferroportin, interact to cause iron sequestration in the setting of inflammation. Although severe anemia is associated with adverse outcomes in critical illness, experimental models suggest that iron sequestration is part of a natural defense against pathogens.