David P. Steensma, MD, Ayalew Tefferi, MD Mayo Clinic Proceedings

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Anemia in the Elderly: How Should We Define It, When Does It Matter, and What Can Be Done? David P. Steensma, MD, Ayalew Tefferi, MD Mayo Clinic Proceedings Volume 82, Issue 8, Pages 958-966 (August 2007) DOI: 10.4065/82.8.958 Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Prevalence of WHO-defined anemia (hemoglobin <13.0 g/dL for males and <12.0 g/dL for nonpregnant females) in the United States, by age and sex. SI conversion factor: to convert hemoglobin value to g/L, multiply by 10. NHANES III = Third US National Health and Nutrition Examination Survey; WHO = World Health Organization. Data from first 2 phases of NHANES III, 1988-1994.7,8 Mayo Clinic Proceedings 2007 82, 958-966DOI: (10.4065/82.8.958) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Prevalence of WHO-defined anemia in US patients aged 65 years or older, by self-declared racial or ethnic group. NHANES III = Third US National Health and Nutrition Examination Survey; WHO = World Health Organization. Data from NHANES III, 1988-1994.7,8 Mayo Clinic Proceedings 2007 82, 958-966DOI: (10.4065/82.8.958) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Unadjusted mortality rate over 11.2 years from the Cardiovascular Health Study, ranked by hemoglobin quintiles. P values for differences across quintiles were <.001 for total mortality, <.001 for noncardiovascular mortality, and .002 for cardiovascular mortality. The lowest quintile was a hemoglobin level less than 13.7 g/dL for men and less than 12.6 g/dL for women. SI conversion factor: to convert hemoglobin value to g/L, multiply by 10. Adapted from Arch Intern Med,19 with permission from the American Medical Association. All rights reserved. Mayo Clinic Proceedings 2007 82, 958-966DOI: (10.4065/82.8.958) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 A proposed algorithm for evaluation of low hemoglobin in older patients. Epo = erythropoietin; MCV = mean corpuscular volume; MDS = myelodysplastic syndrome. Mayo Clinic Proceedings 2007 82, 958-966DOI: (10.4065/82.8.958) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions