title: Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic.
abstract: BACKGROUND
  To accurately determine the causes of anemia and proportion of unexplained anemia in a racially diverse cohort of older adults after a comprehensive and standardized evaluation.
  
  
  METHODS
  We evaluated results from a single-institutional university anemia clinic. Patients with anemia, defined as a hemoglobin less than 13.0 g/dL for men and less than 12.0 g/dL for women, underwent a prospective standardized history, physical examination, and laboratory measures, with additional studies including bone marrow examination as indicated. Empiric treatment trials were given for identified deficiencies.
  
  
  RESULTS
  One hundred and seventy-four primarily community-dwelling adults aged 65 years and older were evaluable. African Americans accounted for 69% of patients and whites were 27%. Anemia etiologies included iron deficiency anemia at 25.3%, anemia of chronic inflammation at 9.8%, and hematologic malignancy in 7.5%. Unexplained anemia in the elderly accounted for 43.7% and predominated in both African Americans and whites. The prevalence of iron deficiency anemia and hematologic malignancies did not differ by race. Unexplained anemia in the elderly showed a consistent phenotype composed of a hypoproliferative mild-to-moderate anemia with suppressed serum erythropoietin. Specifically, erythropoietin levels showed no correlation with hemoglobin concentration in unexplained anemia in the elderly (r = -.15, p = .19) as opposed to iron deficiency anemia (r = -.63, p < .0001).
  
  
  CONCLUSIONS
  In summary, an intensive hematologic evaluation reveals a wide number of anemia etiologies among older adults, including 7.5% with hematologic malignancies; nevertheless, unexplained anemia in the elderly prevails as the most common category in whites and African Americans.
authors.affiliation: Section of Hematology/Oncology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60605, USA. aartz@medicine.bsd.uchicago.edu
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Artz
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thirman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000375:Aging; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000453:epidemiology; D002908:Chronic Disease; D015331:Cohort Studies; D004921:Erythropoietin / Q000097:blood; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000150:complications; D008297:Male; D010044:Outpatient Clinics, Hospital; D015995:Prevalence; D011446:Prospective Studies; D012017:Referral and Consultation; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin