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PubMed2003

Anemia at the end of life: prevalence, significance, and causes in patients receiving palliative care.

While data exist on the prevalence and causes of anemia in defined groups of the elderly, information on palliative care patients is limited. Compared to actively treated oncology patients, for whom anemia treatment has demonstrated improved quality of life and symptom alleviation, studies of treatment outcomes in palliative care patients are limited. Knowledge of the extent and causes of anemia in palliative care patients is needed, as correction of anemia in these patients could potentially improve their physical, emotional, and cognitive functioning. In the present study, clinical data and blood test results of 105 patients meeting specific eligibility criteria were examined to estimate the prevalence of anemia and investigate its causes. Ninety-five (90.5%) patients had advanced cancer. Based on World Health Organization criteria, anemia was found in 77% of men (Hb <130 g/l) and 68.2% of women (Hb <120 g/l). The diagnosis was anemia of chronic disease in 76.7% of women and 46.8% of men. Patients with prostate cancer had a significantly lower mean Hb level (P=0.007) and more evidence of bone metastases (P=0.0007) than those with other cancers. Neutrophil hypersegmentation, suggesting occult folate deficiency, was present in 28.6% of patients, being more common in those with major weight loss (58.3%) than those with moderate (37%) or mild/no weight loss (26%) (P=0.019). The findings suggest that anemia is highly prevalent in the palliative care setting. Although anemia of chronic disease is most common, occult folate deficiency may be more prevalent than previously suspected. The findings suggest that a low serum folate level is an insensitive marker of occult folate deficiency. A randomized controlled trial of folic acid treatment is proposed.

Adult↗
PubMed2000

Red cells II: acquired anaemias and polycythaemia.

Iron deficiency affects 30% of the world's population. Iron metabolism is tightly regulated, with both gut transport and storage being coordinated. Hereditary haemochromatosis due to mutations in the HFE gene leads to increased absorption of iron and multiple end-organ damage. Myelodysplastic disorders are acquired clonal stem-cell disorders that cause ineffective erythropoiesis. Aplastic anaemia is caused by an intrinsic defect of haemopoietic stem cells; both inherited and acquired forms occur. Primary polycythaemia is a myeloproliferative disorder, a non-malignant stem-cell disease.

Anemia↗
PubMed1986

Haematological abnormalities in oral lichen planus, candidiasis, leukoplakia and non-specific stomatitis.

A series of 322 patients presenting with non-ulcerative conditions of the oral mucosa was examined for haematological abnormalities. The series was divided into 5 major groups--lichen planus (103 patients), candidiasis (50), leukoplakia (30), stomatitis or glossitis (66), and a miscellaneous group (73). The prevalence of anaemia, and deficiences in iron, folate and vitamin B12 in each group were compared with that found in 100 controls. The prevalence of anaemia in the series as a whole was not significantly increased, but the prevalences of sideropenia (14.0%), folate deficiency (4.7%) and vitamin B12 deficiency (3.1%) were increased as compared with controls. The prevalence of a haematological abnormality was increased in patients with lichen planus (18/103 p less than 0.05), stomatitis (15/66 p less than 0.01) and particularly in patients with Candidiasis (18/50 p less than 0.001). In the stomatitis group, approximately 45% of the male patients were found to have some haematological deficiency compared with less than 20% of the female patients. The increased prevalence of haematological deficiences suggests that patients presenting with non-ulcerative conditions of the oral mucosa (particularly candidiasis and non-specific stomatitis) should be screened haematologically and that, in some patients with candidiasis, haematological deficiencies may predispose towards candidal infection.

Adolescent↗
PubMed1982

The prevalence and the etiology of the nutritional anemias in Guyana.

A survey was carried out in Guyana to determine the prevalence and the etiology of the nutritional anemias among both sexes, in various age groups, and in pregnant and lactating women. The sample consisted of 590 subjects drawn from 103 households selected by multistage cluster sampling. Anthropometric and hematological measurements and stool investigations for intestinal parasites were carried out in each subject. Socioeconomic and other demographic data were obtained for each household. High prevalences of anemia, although of a relatively mild degree, were found among all age groups especially among pregnant and lactating women. The major factors related to Hb levels were found to be inadequate consumption of food rich in the erythropoietic nutrients, iron deficiency, age, sex, pregnancy, household income, and percentage of household income spent on food. A number of socioeconomic and other demographic variables were associated with anemia. More anemia was found in urban than in rural areas.

Adolescent↗
PubMed1975

Treatment of anemia in the aged: a common problem and challenge.

The occurrence of anemia in a group of aged persons residing in a home for the aged and in a chronic disease hospital was reviewed with regard to etiology, choice of treatment, and therapeutic response. Of the 484 patients, 151 (31 per cent) had anemia or were receiving antianemia therapy. Iron-deficiency anemia was the most common type, and iron was the most common form of treatment. Seventy-eight patients were given antianemia therapy in 97 courses, and a good therapeutic result was achieved in about one-fourth of the courses. The most frequent error in iron therapy was its use in the anemia associated with chronic disorders. Often there was a combination deficiency of iron, vitamin B12 and folic acid. The response to iron in the elderly can be very slow, so therapy should not be discontinued too soon. Anemia may directly contribute to other serious pathologic conditions, especially in aged persons with impaired circulation. In some cases the physiologic concentration of hemoglobin may be higher than the accepted "normal" value. The course of the anemia in relation to the general state of the patient is more significant than any laboratory data in choosing antianemia therapy. Practical laboratory screening procedures for elderly anemic patients are discussed.

Aged↗
PubMed1970

A psychiatric study of patients with diseases of the small intestine.

A group of 80 patients with diseases of the small intestine were given a standardized psychiatric assessment every time they attended the outpatients' department over a period of a year. Forty-six patients with idiopathic steatorrhoea, 23 patients with Crohn's disease, and 11 patients with alactasia were interviewed on 158 occasions. During this time 27 of them (34%) were found to be psychiatrically ill, their illnesses being minor affective disorders. Psychiatric illness was not related either to generalized malabsorption or to deficiencies of specific substances such as folic acid. Although a clear relationship was demonstrated between emotional disturbances and bowel action, diarrhoea was neither sufficient nor necessary for psychiatric illness, and distress associated with diarrhoea was unusual. No single characteristic type of personality was found in any of the patients with the three diseases, but some traits were considerably more commonly associated with some of the diseases than others, and patients with psychiatric illness were shown to attend the outpatients' department more frequently than stable patients. Patients with a family history or a previous history of psychiatric illness, or with depressive traits in their previous personality, were much more likely to fall ill in the survey year. A positive family history of psychiatric illness was significantly more common in idiopathic steatorrhoea. Three patients suffered relapses in the survey year, and in all of these the relapse appeared to be related to emotional factors.

Celiac Disease↗
PubMed1986

Comparison of the nutritional state of new and long-term patients in a psychogeriatric unit.

Nutritional deficiencies have been implicated in the pathophysiology of various mental disorders. Life in institutions has been associated with development of nutritional deficiencies, the elderly being most at risk especially those with senile dementia. In this study nutritional status, particularly vitamin and essential mineral status was assessed in a group of 64 new admissions to a psychogeriatric unit and 49 long-term patients. The results indicated that psychogeriatric patients were at risk of experiencing nutritional deficiencies and those with senile dementia were likely to have more abnormalities than those with functional illnesses. Those patients in long-term care would appear to have a better nutritional state than those on admission.

Aged↗