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JohnWBurns
@johnwburns

Posts: 300
Joined: Jun 02, 2015

Anemia in the elderly

Posted by @johnwburns, Aug 20, 2016

Like a lot of other things it has a bigger impact on older folks. Any condition where cardiac function is compromised, heart failure for example, will likely be made worse by anemia.

http://emedicine.medscape.com/article/1339998-overview

Heart failure example:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569049/

If you have iron deficiency anemia for example, get it treated, but don’t assume that you have it and treat it yourself. The reasons for it can be complex and self treating can be worse than the condition.

Jim

REPLY

Timely information for me, Jim. Thanks. I found this statement in the first article disheartening “For unexplained anemia, no treatment has been well studied.” There are so many multifactorial causes to anemia and often it remains unexplained.

Good warning about self treating.

Liked by JohnWBurns

@colleenyoung

Timely information for me, Jim. Thanks. I found this statement in the first article disheartening “For unexplained anemia, no treatment has been well studied.” There are so many multifactorial causes to anemia and often it remains unexplained.

Good warning about self treating.

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I’ve have a normocytic anemia for as long as I’ve had blood tests and nobody can explain it. Ferritin can go low normal but the anemia doesn’t respond to iron. I put this out there because factors like anemia amplify a lot of the troubles of old age. including things like falling and cognitive decline. True it is disheartening if a root cause is never found and addressed but, If it turns out to be an easy fix, like iron or b12, somebody can feel a lot better with a low investment. Good bang for the buck.

@colleenyoung

Timely information for me, Jim. Thanks. I found this statement in the first article disheartening “For unexplained anemia, no treatment has been well studied.” There are so many multifactorial causes to anemia and often it remains unexplained.

Good warning about self treating.

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Interesting brief report with a table on Wikipedia, Jim. Pretty superficial and perhaps obsolete in your terms, but it lists some causes it speculates to be worth considering. See: https://en.wikipedia.org/wiki/Normocytic_anemia.

Liked by JohnWBurns

@colleenyoung

Timely information for me, Jim. Thanks. I found this statement in the first article disheartening “For unexplained anemia, no treatment has been well studied.” There are so many multifactorial causes to anemia and often it remains unexplained.

Good warning about self treating.

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Thanks Martin. Been down all of this rabbit holes. For this discussion I wanted to make older folks more aware of the potential for mischief the usual anemias have. My impression is that a lot of the time people will look at the big picture, their primary disease or condition, and tend to ignore things they may consider of less consequence. Their doctors might too.
Jim

@colleenyoung

Timely information for me, Jim. Thanks. I found this statement in the first article disheartening “For unexplained anemia, no treatment has been well studied.” There are so many multifactorial causes to anemia and often it remains unexplained.

Good warning about self treating.

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@johnwburns, I’ve been seeing low hemoglobin in a string of blood draws over the past year, and low protein. In 2015, the hemoglobin was high. This week, a draw indicated low iron. Endoscopy and colonoscopy show no abnormalities. It’s been 7 years since I had peptic ulcers removed, and had to stop taking NSAIDS. I have idiopathic peripheral neuropathy, and recently had a spinal cord stimulator implant, which is making a big difference in the burning pain in my feet. I’m a couple of weeks from being 67, and I take meds for neuropathy, depression, anxiety, other pain. I’m trying to figure out what’s causing the anemia. Maybe there’s another discussion on the subject that has informative conversation.

Jim

@colleenyoung

Timely information for me, Jim. Thanks. I found this statement in the first article disheartening “For unexplained anemia, no treatment has been well studied.” There are so many multifactorial causes to anemia and often it remains unexplained.

Good warning about self treating.

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I’m 76, female, had hip replacement surgery years ago, surgeon damaged nerve, thus neuropathy. My blessed family doctor came across info that this very old drug called imipramine in low dosage helps tremendously with the burning of the feet. Been on it for years, together with 100 mg of gabapentin a night. Have no burning anymore. Ck with ur doc, see what he says.

thank you for being here for us. i have many health issues. taking 14 prescription medications can give you some what of an understanding. one of the issues is chronic b12 deficiency. now am 80 years. have had this anemia for over 35 years. only treatment given is monthly b12 shot for 3 months othen to stoand then to stop. and 6000 mgs of sublingual pill daily. it was so bad this last time that the md said it was off the chart and how is it i am still walking! i was pretty bad and felt as though i would faint. anyway, i am quite active and will not stop doing everything by myself. keeping as busy as i can. question: i have 2 or 3 auto immune diseases. can these be affecting the anemia? or, i think it is mostly part of the aging process.

@peach414144

thank you for being here for us. i have many health issues. taking 14 prescription medications can give you some what of an understanding. one of the issues is chronic b12 deficiency. now am 80 years. have had this anemia for over 35 years. only treatment given is monthly b12 shot for 3 months othen to stoand then to stop. and 6000 mgs of sublingual pill daily. it was so bad this last time that the md said it was off the chart and how is it i am still walking! i was pretty bad and felt as though i would faint. anyway, i am quite active and will not stop doing everything by myself. keeping as busy as i can. question: i have 2 or 3 auto immune diseases. can these be affecting the anemia? or, i think it is mostly part of the aging process.

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Hi, @peach414144 You sure we are not closely related somehow? Anyway, I have also been trying to fight a low-grade anemia for at least 60 years. A few years ago a medico in a hospital someplace (kiddingly, I thought) asked if I thought I might have “a plastic anemia”. Knowing that he was something of a clown, I just laughed it off. I did not know what he was talking about, but he was certainly telling a joke….I thought. Only recently I have begun to realize that “aplastic anemia” is not a joke, but a serious medical problem which often comes as part of some autoimmune disorder, such as mis-folded protein deposit disease, etc. Like rheumatoid arthritis, etc. Anyway, I have low levels of red blood cells, hematocrit, hemoglobin. So yes, for you and me both, I would suspect that anemia would be part of our packages. Mayo says that a “strong suspicion” that the villain is such a critter as “a(-)plastic anemia!” is a pre-requisite for diagnosis and treatment. The strong suspicion seems to be, in itself, a bit of a symptom. Sounds to me that you are there already.

Hi, @peach414144 You sure we are not closely related somehow? Anyway, I have also been trying to fight a low-grade anemia for at least 60 years. A few years ago a medico in a hospital someplace (kiddingly, I thought) asked if I thought I might have “a plastic anemia”. Knowing that he was something of a clown, I just laughed it off. I did not know what he was talking about, but he was certainly telling a joke….I thought. Only recently I have begun to realize that “aplastic anemia” is not a joke, but a serious medical problem which often comes as part of some autoimmune disorder, such as mis-folded protein deposit disease, etc. Like rheumatoid arthritis, etc. Anyway, I have low levels of red blood cells, hematocrit, hemoglobin. So yes, for you and me both, I would suspect that anemia would be part of our packages. Mayo says that a “strong suspicion” that the villain is such a critter as “a(-)plastic anemia!” is a pre-requisite for diagnosis and treatment. The strong suspicion seems to be, in itself, a bit of a symptom. Sounds to me that you are there already.

@peach414144

thank you for being here for us. i have many health issues. taking 14 prescription medications can give you some what of an understanding. one of the issues is chronic b12 deficiency. now am 80 years. have had this anemia for over 35 years. only treatment given is monthly b12 shot for 3 months othen to stoand then to stop. and 6000 mgs of sublingual pill daily. it was so bad this last time that the md said it was off the chart and how is it i am still walking! i was pretty bad and felt as though i would faint. anyway, i am quite active and will not stop doing everything by myself. keeping as busy as i can. question: i have 2 or 3 auto immune diseases. can these be affecting the anemia? or, i think it is mostly part of the aging process.

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@dear oldkarl thank you for your input. i really appreciate. how can an md from the oncology group where i live, whom i have been seeing for over 7 years, knowing i have both rheumatoid and psoriatic arthritis (among many other ailments) not know what you do? is this a game with them? they should only suffer as we do then maybe the light will come on in their brains. i have never had a depression that has lasted for any length of time. now i do and i am pretty sure it is because of the worsening of the b12 count. i am sure you have helped me to understand myself and this condition in a better light. thank you and i wonder if i should look for another opinion. (yes i will)

@oldkarl

Hi, @peach414144 You sure we are not closely related somehow? Anyway, I have also been trying to fight a low-grade anemia for at least 60 years. A few years ago a medico in a hospital someplace (kiddingly, I thought) asked if I thought I might have “a plastic anemia”. Knowing that he was something of a clown, I just laughed it off. I did not know what he was talking about, but he was certainly telling a joke….I thought. Only recently I have begun to realize that “aplastic anemia” is not a joke, but a serious medical problem which often comes as part of some autoimmune disorder, such as mis-folded protein deposit disease, etc. Like rheumatoid arthritis, etc. Anyway, I have low levels of red blood cells, hematocrit, hemoglobin. So yes, for you and me both, I would suspect that anemia would be part of our packages. Mayo says that a “strong suspicion” that the villain is such a critter as “a(-)plastic anemia!” is a pre-requisite for diagnosis and treatment. The strong suspicion seems to be, in itself, a bit of a symptom. Sounds to me that you are there already.

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@p.s. yes, we might be related knowing this information. (eastern european)?

Eastern European, Viking, Portuguese

@oldkarl

Hi, @peach414144 You sure we are not closely related somehow? Anyway, I have also been trying to fight a low-grade anemia for at least 60 years. A few years ago a medico in a hospital someplace (kiddingly, I thought) asked if I thought I might have “a plastic anemia”. Knowing that he was something of a clown, I just laughed it off. I did not know what he was talking about, but he was certainly telling a joke….I thought. Only recently I have begun to realize that “aplastic anemia” is not a joke, but a serious medical problem which often comes as part of some autoimmune disorder, such as mis-folded protein deposit disease, etc. Like rheumatoid arthritis, etc. Anyway, I have low levels of red blood cells, hematocrit, hemoglobin. So yes, for you and me both, I would suspect that anemia would be part of our packages. Mayo says that a “strong suspicion” that the villain is such a critter as “a(-)plastic anemia!” is a pre-requisite for diagnosis and treatment. The strong suspicion seems to be, in itself, a bit of a symptom. Sounds to me that you are there already.

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Great! I have succeeded!

@oldkarl

Eastern European, Viking, Portuguese

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@looked up aplastic anemia. rheumatoid and psoriatic arthritis can attack the marrow in the bones which in turn causes the damage of the red cells, etc. thus causing the anemia. i do remember the last two attacks of these arthritis (which one i do not know because they take turns, they have a mind of their own.) anyway during these attacks i told the doctors that the pain seems to be inside the bones and travelling up and in the bones. now i know why the pain was so significant and exactly where the pain was. just think, there i am lying in great pain for more than three months while the damage is being done with the doctors knowing this information and NOTHING IS DONE FOR IT. how can they justify themselves by ignoring the obvious? am i the only patient being treated (or not treated) for this? is this ignorance on their part or just that they do not care? questions, questions, questions. the pieces of the puzzle are there and they are just being ignored. is this criminal? i will still smile as long as i can.

A complete blood count with differential can narrow down the list of possible causes of anemia. There is the Red Blood Count, Hemoglobin count, Reticulocyte (immature red cell) count, Hematocrit plus the indices Mean Corpuscular Volume, Mean Corpuscular Hemoglobin and Mean Corpuscular Hemoglobin Concentration. The red blood and hemoglobin analyses alone can rule out many possible causes. The White cell counts can also suggest the presence or absence of conditions associated with anemia, including blood cancers. Iron supplements can do more harm than good and should be avoided unless iron deficiency is confirmed by additional tests.

The effects of anemia are magnified in the presence of lung and cardiovascular diseases and other conditions that can cause fatigue, including lymphoma. Chronic Lymphocytic Leukemia is staged according to hemoglobin and platelet counts, which are indices of bone marrow suppression. However, even in early stages of CLL there can be advanced signs and symptoms of lymphoma, such as night sweats, frequent infections, moderate to severe fatigue and very low immunoglobulin levels together with normal or near-normal hemoglobin levels. Small-cell Lymphocytic Leukemia involves exactly the same type of cell as CLL, but likely originates in a lymph node and spreads to other lymph nodes before it gets established in the bone marrow. SLL looks like, is staged like and treated like some other indolent lymphomas. SLL is staged according to the Ann Arbor system and generally not treated in advanced stages unless there are b-grade symptoms (e.g., night sweats, frequent infections) or bulky lymph nodes, and the goal of treatment is to relieve symptoms and / or reduce lymph node size. CLL often develops characteristics of SLL in late stages, and sometimes in early stages. CLL diagnosed as old rai stage 1 or 2 might actually represent a late stage of SLL that has infiltrated the bone marrow. If there are 4,999 monoclonal lymphocytes in the blood stream at time of diagnosis, it is SLL, and if 5,000 it’s CLL. However, characteristics of SLL can be very prominent in early stages of CLL. CLL specialists usually make treatment decisions in accord with International Workshop Guidelines for Diagnosis and Treatment of Chronic Lymphocytic Leukemia, which allows treatment of early stage CLL with b-grade symptoms or bulky and symptomatic lymph nodes, spleen and other organs. The criteria for and goals of treatment of CLL and SLL can be the same. I know from bitter personal experience that there are hematologists who are either not familiar with or do not agree with International Workshop guidelines, and ignore indications for treatment of an indolent lymphoma because they believe that they are dealing with a form of “leukemia” and not a lymphoma, at least not in early stages.

Disclaimer. I am a Licensed Practical Nurse who completed more advanced coursework in biology that is required for an RN license and have intensively studied subject related to diagnosis and treatment of CLL during the past 3 years, including basic hematology and immunology. I can recommend Mayo Clinic to anyone with CLL because there are CL-specialists within the department of hematology who follow International Workshop guidelines and are focused on treating CLL patients. Mayo Clinic has National Cancer Institute accreditation, which requires a much higher degree of specialization in treatment of cancers than is found in most oncology and hematology practices.

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