Anemia as We Age – Part 2

The following information on anemia is excerpted from “Anemia in the Older Adult: 10 Common Causes & What to Ask,” originally written and published by Leslie Kernisan, MD, on Better Health While Aging.net. I am reposting this with her permission and am sharing it to educate readers about anemia.

The most common causes of anemia

Whenever anemia is detected, it’s essential to figure out what is causing the low red blood cell count.

Compared to most cells in the body, normal red blood cells have a short lifespan: about 100-120 days. So a healthy body must always be producing red blood cells. This is done in the bone marrow and takes about seven days, then the new red blood cells work in the blood for 3-4 months. Once the red blood cell dies, the body recovers the iron and reuses it to create new red blood cells.

Anemia happens when something goes wrong with these normal processes. In kids and younger adults, there is usually one cause for anemia. But in older adults, it’s quite common for there to be several co-existing causes of anemia.

A useful way to think about anemia is by considering two categories of causes:

• A problem producing the red blood cells, and/or
• A problem losing red blood cells

Here are the most common causes of anemia for each category:

Problems producing red blood cells. These include problems related to the bone marrow (where red blood cells are made) and deficiencies in vitamins and other substances used to make red blood cells. Common specific causes include:

• Chemotherapy or other medications affecting the bone marrow cells responsible for making red blood cells.
• Iron deficiency. This occasionally happens to vegetarians and others who don’t eat much meat. But it’s more commonly due to chronic blood loss, such as heavy periods in younger women, or a slowly bleeding ulcer in the stomach or small intestine, or even a chronic bleeding spot in the colon.
• Lack of vitamins needed for red blood cells. Vitamin B12 and folate are both essential to red blood cell formation.
• Low levels of erythropoietin. Erythropoietin is usually produced by the kidneys, and helps stimulate the bone marrow to make red blood cells. (This is the “epo” substance used in “blood doping” by unethical athletes.) People with kidney disease often have low levels of erythropoietin, which can cause a related anemia.
• Chronic inflammation. Many chronic illnesses are associated with a low or moderate level of chronic inflammation. Cancers and chronic infections can also cause inflammation. Inflammation seems to interfere with making red blood cells, a phenomenon known as “anemia of chronic disease.”
• Bone marrow disorders. Any disorder affecting the bone marrow or blood cells can interfere with red blood cell production and hence cause anemia.

Problems losing red blood cells. Blood loss causes anemia because red blood cells are leaving the blood stream. This can happen quickly and obviously, but also can happen slowly and subtly. Slow bleeds can worsen anemia by causing an iron-deficiency, as noted above. Some examples of how people lose blood include:

• Injury and trauma. This can cause visibly obvious bleeding, but also sometimes causes people to bleed into a space inside the body, which can be harder to detect.
• Chronic bleeding in the stomach, small intestine, or large bowel. This can be due to many reasons, some common ones include:
  • taking a daily aspirin or non-steroidal anti-inflammatory drug
  • peptic ulcer disease
  • cancer in the stomach or bowel
• Frequent blood draws. This is mainly a problem for people who are hospitalized and getting daily blood draws.
• Menstrual bleeding. This is usually an issue for younger women but occasionally affects older women.

There is also a third category of anemias, related to red blood cells being abnormally destroyed in the body before they live their usual lifespan. These are called hemolytic anemias and they are much less common.

Problems losing red blood cells. Blood loss causes anemia because red blood cells are leaving the blood stream. This can happen quickly and obviously, but also can happen slowly and subtly. Slow bleeds can worsen anemia by causing an iron-deficiency, as noted above. Some examples of how people lose blood include:

• Injury and trauma. This can cause visibly obvious bleeding, but also sometimes causes people to bleed into a space inside the body, which can be harder to detect.
• Chronic bleeding in the stomach, small intestine, or large bowel. This can be due to many reasons, some common ones include:
  • taking a daily aspirin or non-steroidal anti-inflammatory drug
  • peptic ulcer disease
  • cancer in the stomach or bowel
• Frequent blood draws. This is mainly a problem for people who are hospitalized and getting daily blood draws.
• Menstrual bleeding. This is usually an issue for younger women but occasionally affects older women.

There is also a third category of anemias, related to red blood cells being abnormally destroyed in the body before they live their usual lifespan. These are called hemolytic anemias and they are much less common.

A major study of causes of anemia in non-institutionalized older Americans found the following:

• One-third of the anemias were due to deficiency of iron, vitamin B12, and/or folate.
• One-third were due to chronic kidney disease or anemia of chronic disease.
• One-third of the anemias were “unexplained.”