title: Unexplained anaemia in older persons is characterised by low erythropoietin and low levels of pro-inflammatory markers.
abstract: Epidemiological studies report that a third of the cases of anaemia in older persons is unexplained. We compared erythropoietin (EPO), inflammatory markers and major comorbidities between older subjects with normal haemoglobin levels and those with different aetiologic forms of anaemia, including unexplained anaemia. Participants were a representative sample of 964 persons aged > or =65 years, with no evidence of bleeding, complete blood tests, and a complete blood count within 6 h of phlebotomy. Anaemia was defined as haemoglobin <130 g/l in men and 120 g/l in women, and classified as a result of chronic kidney disease, iron deficiency, chronic disease and B12/folate deficiency anaemia, or unexplained anaemia based on standard criteria. Of the 124 anaemic participants, 42 (36.8%) had unexplained anaemia. Participants with anaemia of chronic diseases had significantly higher interleukin-6 (IL-6) and C-reactive protein (CRP) levels, while those with unexplained anaemia had significantly lower CRP than non-anaemic controls. Iron deficiency anaemia was characterised by significantly higher EPO levels compared with other types of anaemia and normal haemoglobin, B12 and/or folate deficiency. Unexplained anaemia was characterised by unexpectedly low EPO and low lymphocyte count. Unexplained anaemia is associated with reduced kidney EPO response, low levels of pro-inflammatory markers and low lymphocyte counts.
authors.affiliation: Intramural Research Program, National Institute on Aging, Baltimore, MD 21225, USA. ferruccilu@grc.nia.nih.gov
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Stefania
authors.initials: S
authors.lastname: Bandinelli
authors.forename: Richard D
authors.initials: RD
authors.lastname: Semba
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lauretani
authors.forename: Annamaria
authors.initials: A
authors.lastname: Corsi
authors.forename: Carmelinda
authors.initials: C
authors.lastname: Ruggiero
authors.forename: William B
authors.initials: WB
authors.lastname: Ershler
authors.forename: Dan L
authors.initials: DL
authors.lastname: Longo
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D000740:Anemia / Q000097:blood* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000097:blood; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000097:blood; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D006306:Health Surveys; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D007558:Italy; D007674:Kidney Diseases / Q000097:blood; D018655:Lymphocyte Count; D008297:Male; D010003:Osteoarthritis / Q000097:blood; D010300:Parkinson Disease / Q000097:blood; D020521:Stroke / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D004921:Erythropoietin; D002097:C-Reactive Protein