Hematologic Screening Tests for Latent Anemia to Aging Population, a Practical Study of Laboratory Medicine

Description

Epidemiologic studies have suggested that anemia may be associated with poorer outcomes in a variety of disorders. In many studies the definition of anemia used is that suggested by a World Health Organization (WHO) expert committee over 40 years ago. Traditionally, anemia in general population has been• defined by criteria developed by the World Health Organization (WHO) in 1968. The World Health Organization (WHO) traditionally defines anemia in adults as a hemoglobin (HGB) concentration of < 130 g/L, (13 g/dL), for adult males and < 120 g/L (12 g/dL) for adult non-pregnant females. These foundational thresholds were established by WHO and are still used as standard benchmarks for assessing anemia in individuals and populations. However, these thresholds are generalized baselines. The actual criteria for what are considered normal or low can vary depending on individual factors, including: age, (older adults may require adjusted interpretations), pregnancy status, altitude (people living at high altitudes often have higher HGB requirements), and specific underlying health conditions (such some chronic disease, as kidney disease [1]. Defining Anemia in the Elderly here is some evidence that blood HGB may decline slightly with age. For this reason, the anemia can be defined as a decrease of HGB with 10% from initial normal value to persons with age >_66 years. Results from the 1988-1994 United States National Health and Nutrition Examination Survey (NHANES III) indicate that fewer than 3% of adults aged 65 and older have hemoglobin levels below 110 g/L, and therefore most anemia cases among community-dwelling older adults are mild [2]. Nonetheless, recent evidence indicates that even mild anemia is independently associated with increased risk of recurrent falls, poorer physical function, hospitalization, and mortality in older adults. [3] While a number of studies have reported differential distributions of anemia by age and sex, less attention has been devoted to disparities in anemia by race, [4, 5, 6]. According to NHANES III estimates, older non-Hispanic blacks were 3 times more likely to have anemia compared to older Hispanic whites (27.8% vs 9.0%). Similar disparities in anemia prevalence have been observed in other population-based studies of older blacks and whites with hematologic parameters in red blood disorders from peripheral blood. Anemia in the elderly is an extremely common problem that is associated with increased mortality and poorer health-related quality of life, regardless of the underlying cause of the low HGB. A recent study in Iceland defined mild anemia as a HGB concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. This cross-sectional analysis provides evidence of HGB in 36.7% of hospitalized patients, and shows an association among anemia, poor nutritional status and inflammation.

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Method The purpose of this study was to determine the prevalence and causes of HGB among older adults hospitalized at an academic medical center. The prospective study consisted of 140 consecutive patients over age 65 (80 male, 60 female) hospitalized for stroke (n=25), chronic hepatic diseases (n=45), complications of atherosclerosis (n = 35), chronic cardiac disorders (n=20), and breast carcinoma (n=15), admitted in hospital after a preliminary ambulatory consult of specialist physicians. Laboratory tests were performed within the first 4-5 days of hospitalization. Clinical diagnoses were established by the physicians caring for the patients. In the medical analyses laboratory analyses, in hematologic department, all patients had complete blood count analyzed on Coulter HMX Analyzer with 22 parameters and measurements of serum iron and iron binding capacity done on Vitros 700, Biochemic Analyzer). Reticulocyte count (RET %) was calculated after microscopic analysis with brilliant cresyl blue stained slides, (normal ranges adult: 0.5 - 1.5%). To evaluate rate of erythropoiesis, the Reticulocyte Production Index, (RPI), was calculated using the formula: [RPI = RET% x HCT patient /45 /reticulocyte time maturation], where maturation time ,(reticulocytes survival days in peripheral blood), was considered 1 day for HCT 36-45%, 1.5 days for HCT 26-35%, 2 days for HCT 16- 25% and 2.5 days for HCT < 15% [10]. Reference interval for RPI in healthy individuals is 1.0-2.0; RPI < 2 in a person with anemia indicates ineffective erythropoiesis, while values > 2 indicate compensation for decreased red cell survival (bleeding, hemolysis). In average mean, to 40 health patients, at HMX Coulter Hematologic analyzer, shown WBC=9700/dl; RBC=4500 000/dl; HGB=13,9g/dl; HCT=42.2%; MCV=93fl; MCH=30,6pg; MCHC=33μg/dl; R DW=15.1 units; PLT=270 000/dl; MPV=8,2fl; LIMPH=26-28%; MONO=6.3%; GRAN=62-68%. Complete Blood Count, (CBC), with blood cells, red blood cells and platelets were measured by assaying one specimen from every patient for HGB, number red blood cells, (RBC), hematocrit, (HCT), mean cellular volume (MCV), Red Cell Distribution Width, (RDW), and white blood cells, (WBC), on automated hematology analyzer, Coulter HMX. Reticulocyte measurement included percentage of reticulocytes (%, ret) and absolute reticulocyte count, (# RET = no. red blood cells x % ret). Results Abnormal CBC results were common in hospitalized elderly individuals. Only 33 patients (23.58%) had normal results for all hematological parameters in the CBC, while another16 (11.4%) patients had normal HGB and HCT, but low MCV (average=72 fL, SD= 2.1) or MCH (average=24.3pg, SD= 1.6). Of the 91 anemic individuals, 63 (69.2%) had mild anemia (HGB decreased but > 10.6 g/dL), while the remaining 28, (30.8%,) had severe anemia. All individuals in the group with severe anemia had low RET, (mean 1.2%, range 0.5-1.5%), and RPI <1.4, indicating a hypo-regenerative type of anemia.

Institutions

• Titu Maiorescu University

  București, Bucharest

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Funders

• Unitatea Executiva Pentru Finantarea Invatamantului Superior a Cercetarii Dezvoltarii si Inovarii

  National Research Council

  București, Bucharest

  Grant ID: U-1900-063Y4656

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