Definitions & Epidemiology
What are the traditional hemoglobin cutoffs that define anemia in men and women?
Men < 13 g/dL, women < 12 g/dL
What is the first test to obtain when evaluating normocytic or microcytic anemia?
Serum ferritin level
What common source should be evaluated in older adults with iron deficiency?
GI malignancy (via endoscopy)
What is the first test to evaluate macrocytic anemia?
Peripheral smear and reticulocyte count
What is the general transfusion threshold for symptomatic anemia in older adults?
Hb ≤ 8 g/dL
What is the overall prevalence of anemia in older adults?
~17% overall (7–11% community, 40% hospitalized, 47% in nursing homes)
What MCV range defines normocytic anemia?
80–100 fL
What is the typical hemoglobin response timeline after starting iron therapy?
6-8 weeks
What are the two most common nutritional causes of macrocytic anemia?
Vitamin B12 and folate deficiency
What is the target hemoglobin when using erythropoiesis-stimulating agents?
11 g/dL
What fraction of older adults with anemia have a nutritional deficiency?
One-third
What ferritin threshold is highly suggestive of iron deficiency?
<19 ng/mL
What low-dose iron regimen can be effective with fewer side effects?
15 mg elemental iron daily
Which medications are associated with vitamin B12 deficiency?
PPIs, H2 blockers, and metformin
When should labs be rechecked after parenteral iron infusion?
6–8 weeks post-treatment
What are two key functional consequences of anemia in older adults?
Decreased mobility and increased risk of falls/delirium
What index helps distinguish iron deficiency anemia from anemia of chronic disease when ferritin is 46–100 ng/mL?
Serum transferrin receptor–ferritin index (>1.5 = IDA)
Name one strategy to improve oral iron absorption.
Take on empty stomach or with vitamin C/orange juice
Why must vitamin B12 deficiency be corrected before folate deficiency?
Folate repletion can mask B12 deficiency and worsen neurologic injury
What are two major risks associated with erythropoiesis-stimulating agents (ESAs)?
Thromboembolism and increased mortality
How is anemia associated with mortality in older adults?
Each 1 g/dL decrease in hemoglobin is associated with 11–39% higher mortality risk
After excluding iron deficiency and CKD, what are the next diagnostic steps for unexplained anemia?
Peripheral smear and reticulocyte count, then targeted evaluation (e.g., myelodysplasia)
What are two indications for parenteral iron?
Oral intolerance/malabsorption, or ongoing blood loss exceeding oral replacement
What finding on a peripheral smear suggests myelodysplastic syndrome?
Dysplastic cells, hypogranulated or hyposegmented neutrophils, macro-ovalocytes
What condition should be considered in patients unresponsive to iron therapy?
Celiac disease