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Q: I'm 80 years old, and I'm always very tired and short of breath. My doctor says I have low hemoglobin, but my iron level is OK.
The problem is my bone marrow is not producing. What should I do now?
You
have stated that you have anemia (a low hemoglobin concentration, less than 12
g/dl) that does not result from iron deficiency. Anemia is in fact a common
problem among older adults.
Anemia is diagnosed by a complete blood count. Other tests might include
further blood work to evaluate iron, ferritin, Vitamin B12 levels, folic acid,
and
lactic dehydrogenase; and an electrophoresis of the proteins in the serum. A
bone marrow biopsy and aspirate might also be necessary. This test involves
insertion of a needle directly into the pelvic bone to withdraw marrow for
examination under the microscope. It is a brief, safe, yet somewhat
uncomfortable procedure that can help your doctor determine the cause of the
anemia.
The most common form of anemia in older adults is "anemia of chronic
disease (or disorder)," also referred to as ACD. With ACD, there is sufficient iron
present in the body, but the bone marrow is unable to incorporate it into the
red blood cells. ACD might be associated with cancer, chronic renal failure,
collagen vascular disease, or a chronic infection. When the underlying disease
is cured, the anemia resolves. Many times, however, the underlying cause might not
be readily apparent. Some doctors offer patients a trial of erythropoietin.
This is an expensive medicine, available only in injection form, and might not
be covered by your insurance. It is reasonable to try it if you have symptoms
from your anemia.
The second most common form of anemia is iron deficiency. In this case, tests
must be done to discover the source of bleeding and the iron must be replaced.
In some cases, the iron might not be absorbed well by mouth, and intramuscular
(injected directly into the muscle) or intravenous (injected into a vein) iron
is needed.
Vitamin B12 deficiency is also a common cause of anemia, and this condition
might be referred to as pernicious anemia. Some people respond to high doses of
oral Vitamin B12 (1000 mcg per day). If the B12 is not absorbed, then
intramuscular injections are given every one to three months, depending upon the
individual requirement. You can learn to do this yourself, or have someone in
your family administer it.
Other causes of anemia in older adults include aplastic anemia,
myelodysplasic syndrome, folate deficiency, thalassemia, sideroblastic anemia,
and hemolytic anemia. Multiple myeloma might present with anemia, elevated
calcium, and kidney failure.
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