Submit Manuscript | http://medcraveonline.com Introduction Modern health and social care face growing challenges for a rapidly ageing population due to the signifcant advances in public health, medical and pharmacological research and preventive medicine. People over the age of 80 are the fastest-growing part of the population and are expected to reach nearly 30% of the total population in Western societies by the 2050 year. 2 Ageing is usually accompanied by chronic (multiple) diseases, disability, weakness and social isolation. 3 Anaemia is a common syndrome in the elderly (age>65 years), but its spread should not be considered an inevitable ageing consequence. Over the last decade, it has emerged as a signifcant risk factor associated with various adverse outcomes in the elderly, including increased hospitalization, disability and mortality. 4 Defning anaemia Anaemia is defned as a decrease in haemoglobin and/or erythrocytes and hematocrit below the lower reference limit for healthy individuals, necessarily consistent with gender, age, race, altitude, etc., environmental factors. The overall incidence of anaemia in the elderly is about 12-17%, reaching 47% in those living in nursing homes and up to 40% in hospitalized patients. 5 Its prevalence can get nearly 50% in men over 80 in both hospital and outpatient patients. 1 Anaemia is essentially a homeostatic imbalance in the concentration of haemoglobin in the blood, in which the destruction or loss of erythrocytes is more signifcant than their production. 4 According to WHO criteria for anaemia, haemoglobin (Hb) values are below 130 g/L in men, below 120 g/L in women and less than 110 g/L in pregnant women and children. For the elderly, haemoglobin values have diferent reference limits that do not meet the above criteria. However, most clinicians accept the WHO defnition and believe that the normal range of haemoglobin in the elderly should not be adjusted due to its association with morbidity, mortality and hospitalizations. 6 Reference limits for normal haemoglobin vary from laboratory to laboratory. They usually depend on the method of determination, the automatic cell counter and the reagents used by a laboratory. Most guidance in clinical practice is to determine the haemoglobin reference limits according to age and sex for a given population group associated with a particular lifestyle and culture. It is difcult to fnd a reference group of “healthy” adult subjects due to the high percentage of comorbidities and disabilities with age. For example, in the analysis of Cheng et al. 7 60 % of the elderly were excluded from the reference group due to common diseases, including obesity, hypertension, diabetes, recent treatment of anaemia or recent surgery or hospitalization. The introduction of this approach limits its practical applicability. Another approach is based on determining optimal Hb concentrations for the clinical course and with minimal risk of adverse outcomes in the elderly. A study in an adult group for cardiovascular health assessment found increased mortality in the lower quintile for haemoglobin <137 g/L for men and <126 g/L for women was found. 8 Several studies have shown that anaemia correlates with increased hospitalization 9 and poorer survival in the elderly. 10 For example, mild anaemia or the so-called “low-normal” haemoglobin level is associated with a wide range of more adverse health problems. For example, patients with heart failure with haemoglobin levels in the lowest quartile have more symptoms, poorer hemodynamics, and higher mortality than those with higher haemoglobin levels. 11 The proposed optimal Hb value to avoid hospitalization and mortality is 130–150 g/L for women and 140–170 g/L for men, suggesting a redefnition of the limit values for anaemia. 6 Diagnostic aspects Anaemia is a multifactorial condition that accompanies increased comorbidity in the elderly. Diagnosis and treatment in this age group often require a multidisciplinary approach and detailed studies of the functional state of the organs. 1 The most common causes of anaemia in the elderly include reduced nutrition with nutritional defciencies, chronic infammatory diseases, chronic renal failure, liver disease, occult blood loss in degenerative and malignant gastrointestinal tract diseases, and suppression of hematopoiesis (decline in proliferation stem cells from drugs, alcohol use, chronic diseases, myelodys plastic syndrome (MDS), etc.). However, in many patients, the aetiology may remain unknown. 1 History and clinical status should focus on identifying risk factors and symptoms specifc to a specifc condition. For example, melena, hematochezia, and weight loss may indicate neoplastic gastrointestinal bleeding. Primary laboratory evaluation in elderly patients with anaemia should include basic parameters, including Hb, diferential blood count, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), reticulocyte count, ferritin, erythropoietin level (EPO), C -reactive protein (CRP), MOJ Gero & Geri Med. 2021;6(4):122‒125. 122 ©2021 Yordanova. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Anaemia - a common syndrome in old age Volume 6 Issue 4 - 2021 Mariana Georgieva Yordanova Department of Clinical Laboratory, Military Medical Academy, Multiprofle Hospital for Active Treatment- Varna, Bulgaria Correspondence: Mariana Georgieva Yordanova, Department of Clinical Laboratory, Military Medical Academy, Multiprofle Hospital for Active Treatment, Medical University of Varna, Bulgaria, Tel +359882799904, Email Received: December 01, 2021 | Published: December 16, 2021 Abstract Anaemia is a common syndrome in the elderly (age>65 years), combined with changes and diseases characteristic of ageing. There are currently nearly 500 million (7%) adults over the age of 65 in the world. According to statistics, there are about 15 million older people with anaemia in the European Union. This number is likely to increase in the coming years due to the ageing population in Western societies. 1 The acute anaemic syndrome is dominated by symptoms of decreased circulatory volume, such as dizziness, syncope and hypotension. While in the chronic course, anaemia can be asymptomatic and be detected accidentally in a laboratory test. Suspicious signs are a reduced ability to carry oxygen, such as general weakness, fatigue and shortness of breath, for which age changes are often blamed. Worsening of concomitant conditions such as angina, heart failure, CKD and chronic obstructive pulmonary disease has been observed. Older people with anaemia of any degree have a deteriorating quality of life due to signifcantly higher morbidity and mortality. The purpose of this review is to summarize the most common etiological causes of anaemia in the elderly, clinical consequences, and guidelines for diagnosis. MOJ Gerontology & Geriatrics Mini Review Open Access