Maybe It’s Not Just Aging. Maybe It’s Anemia.

Gary Sergott felt tired all the time. “I would be tired, breathtaking, a kind of discomfort,” he said. It was even cold on hot days and looked pale with dark circles before his eyes.

His illness was not mysterious. As a retired anesthesiologist, Sergott knew he had anemia, a deficiency in red blood cells. In his case, it is the consequence of a hereditary condition which caused almost daily nose bleeding and exhausted his hemoglobin, the protein of red blood cells which delivers oxygen throughout the body.

But by consulting the doctors on his fatigue, he found that many did not know how to help. They advised Sergott, who lives in Westminster, Maryland, to take iron tablets, usually the first line treatment of anemia.

But like many elderly people, he found a daily diet of four to six tablets that are difficult to tolerate. Some patients taking iron complain of severe constipation or stomach cramps. Sergott felt “nausea all the time”. And iron tablets do not always work.

After almost 15 years, he found a solution. Michael Auerbach, hematologist and oncologist who is co -director of the Center for Cancer and Blood Disorders in Baltimore, suggested that Sergott receives iron intravenously instead of orally.

Now, Sergott, 78, obtains an hour -long infusion when his hemoglobin levels and other markers show that he needs it, generally three times a year. “It’s like filling the fuel tank,” he said. His symptoms retreat and “I feel good”.

Its history, however, reflects the frequent rejection of a common condition, which can not only decrease the quality of life of the elderly, but also lead to serious consequences on health, in particular falls, fractures and stays in the hospital.

Symptoms of anemia – fatigue, headache, leg cramps, coldness, decrease in the ability to exercise, brain fog – are often attributed to aging itself, said William Ershler, said hematologist and researcher. (Some people with anemia remain asymptomatic.)

“People say,” I feel weak, but everyone feels weak, “said Ershler.

Even if hemoglobin levels are likely to have been included in the files of their patients, as part of the complete blood count, or CBC, regularly ordered during medical visits, doctors do not often recognize anemia.

“Patients come to the clinic and undergo blood tests, and nothing happens,” he said.

Anemia affects 12.5% of people over the age of 60, according to data from the most recent survey of the national survey of health and nutrition exams, and the rate later increases.

But this can be an underestimation.

In a study published in the Journal of the American Gériatrics Society, Ershler and his colleagues examined electronic health files of almost 2,000 external patients over 65 in Inova, the major health system based in northern Virginia from which he recently retired.

Based on the results of blood tests, the prevalence of anemia was much higher: around 1 in 5 patients was anemic, with levels of hemoglobin lower than normal as defined by the World Health Organization.

However, only about a third of these patients had properly documented anemia in their medical graphics.

Anemia “deserves our attention, but it does not always get it,” said George Kuchel, a geriatrician at the University of Connecticut, who was not surprised by the conclusions.

It is partly because anemia has so many causes, some more treatable than others. In perhaps a third of the cases, it results from a nutritional deficiency – generally a lack of iron, but sometimes of vitamin B12 or Folate (called folic acid in synthetic form).

The elderly may have decreased appetites or find it difficult to shop for food and prepare meals. But anemia can also follow blood loss of ulcers, polyps, diabetes and other causes of internal bleeding.

Surgery can also cause iron deficiency. Mary Dagold, 83, retired librarian in Pikesville, Maryland, underwent three abdominal operations in 2019. She stayed in bed for weeks later and needed a food tube for months. Even after healing, “anemia has not disappeared,” she said.

She remembers feeling perpetually exhausted. “And I knew I didn’t think about what I usually think,” she added. “I couldn’t read a novel.” His primary care doctor and Auerbach both said that oral iron was unlikely to help.

Iron tablets, available over the counter, are inexpensive. Intravenous iron, becoming more widely prescribed, can cost $ 350 to $ 2,400 per infusion depending on the formulation, said Auerbach.

Some patients find a single dose sufficient, while others will need regular treatment. Medicare covers it when the tablets are difficult to tolerate or ineffective.

For Dagold, an intravenous iron infusion of 25 minutes every five weeks approximately made a surprising difference. “It takes a few days, then you feel good enough to do your daily life,” she said. She returned to her water aerobic lesson four days a week.

In other cases, anemia comes from chronic diseases such as heart disease, renal failure, bone marrow disorders or inflammatory intestine diseases.

“These people are not lacking in iron, but they are unable to treat it to make red blood cells,” said Kuchel. Since iron supplements will not be effective, doctors are trying to treat anemia by treating patients’ underlying diseases.

Another reason to be careful: “Iron loss can be the first warning sign of colon cancer and stomach cancer,” said Kuchel.

However, in a third of patients, anemia remains frustrating. “We have done everything and we have no idea what causes it,” he said.

Find out more about the causes and treatment of anemia could prevent a lot of misery on the road. In addition to his association with falls and fractures, anemia “can increase the severity of chronic diseases – heart, lung, kidney, liver,” said Auerbach. “If it is really serious and hemoglobin goes to fatal levels, it can cause a heart attack or a stroke.”

Among the unknowns, however, it is if the treatment of early anemia and the restoration of normal hemoglobin will prevent subsequent diseases. However, “things happen in this area,” said Ershler, pointing to a workshop on the aging of the National Institute on unexplained anemia held last year.

The American Society of Hematology appointed a diagnostic and processing committee of iron deficiency and plans to publish new directives next year. The Iron Consortium of Oregon Health & Science University summoned an international panel on the management of iron deficiency and recently published its recommendations in Lancet’s hematology.

In the meantime, many older patients can access their CBC results and therefore their hemoglobin levels. The World Health Organization defines 13 grams of hemoglobin per deciliter as usual for men, and 12 for non -pregnant women (although some hematologists maintain that these thresholds are too low).

Ask health care providers on hemoglobin and iron levels, or the use of a patient portal to check the figures themselves, could help patients direct conversations with their doctors of fatigue or other symptoms such as inevitable results of aging.

These are perhaps signs of anemia, and maybe it is treatable.

“There is a good chance that you had a CBC in the past six months or a year,” said Kuchel. “If your hemoglobin is fine, great.”

But, he added, “if it is really outside the normal limits, or if it changed compared to a year ago, you must ask questions.”

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