Anemia: Much More Than Iron-Poor Blood

Remember those old Geritol commercials promising you an elixir for tired blood? With the promise of “twice the iron in a pound of calf’s liver,” you would no longer feel “tired, listless, and rundown.” The Federal Trade Commission eventually stepped in, charging that the product’s ads were misleading and the tonic wasn’t a cure-all for fatigue. Yet, there was some truth behind Geritol’s claims that people with iron-deficiency anemia could benefit from iron supplements.

But anemia can be much more complicated than insufficient dietary iron, especially in older adults. Luckily, most cases of anemia are mild, but if overlooked or left untreated, anemia can lead to weakness, fatigue, shortness of breath, decreased mental function, heart failure, and several other health issues. It can also signal an underlying condition such as cancer, gastrointestinal disease, or a blood disorder.

As we get older, our risk of anemia increases, but anemia isn’t a normal consequence of aging. An estimated 10 percent of Americans 65 and older have some form of anemia. Because anemia has a multitude of causes and forms, it’s critical that it be diagnosed and treated promptly.

What is anemia?

Anemia is defined as an abnormally low count of red blood cells, which contain hemoglobin, the iron-rich protein that transports oxygen throughout the body. When there aren’t enough red blood cells—and therefore not enough hemoglobin—the body doesn’t get enough oxygen. This leads to common symptoms like fatigue, irritability, and weakness.

Some types of anemia are genetic, but in older adults, most forms of anemia are acquired, and it’s possible to have several forms of anemia simultaneously. Below are some common types of acquired anemia.

• Iron-deficiency anemia. This type of anemia is the most common. Insufficient iron consumption can lead to a reduction of red blood cell production. However, nutritional deficiencies are most commonly found in developing countries. Another cause of iron-deficiency anemia is blood loss, which can either be sudden and heavy, such as from an injury, or chronic and slow, such as from internal bleeding or heavy menstrual periods. Gastrointestinal bleeding is a common problem that tends to occur among people who regularly use nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen, or aspirin-containing antacids. Excessive alcohol consumption, colon cancer, and hemorrhoids are some other causes of gastrointestinal bleeding. 
• Anemia of chronic disease. Chronic conditions that cause inflammation (such as inflammatory bowel disease and rheumatoid arthritis), infections (such as HIV/AIDS), and kidney failure are associated with decreased red blood cell production.
• Pernicious anemia. This rare autoimmune disease causes a vitamin B₁₂ deficiency. It stems from a lack of a protein secreted from the stomach known as intrinsic factor. This substance aids in B₁₂ absorption. Fortunately, pernicious anemia can be cured by B₁₂ replacement.
• Other vitamin B₁₂ deficiency anemias. Certain autoimmune diseases, such as type 1 diabetes, Graves disease, and the skin disorder vitiligo are associated with vitamin B₁₂ deficiency anemia. Celiac disease, Crohn’s disease, and intestinal infection, as well as having part of the stomach surgically removed, among other reasons, can interfere with B₁₂ absorption.[inset:4221]
• Aplastic anemia. This rare anemia is a result of damaged bone marrow, the spongy tissue in the center of the bones essential to producing blood cells. Marrow is often damaged by cancer treatments, toxic substances such as pesticides, certain infections, and some autoimmune diseases such as rheumatoid arthritis and lupus.
• Hemolytic anemia. This anemia occurs when red blood cells are destroyed or damaged faster than the bone marrow can produce new cells. Its many causes include some cancers, autoimmune disorders, malaria, exposure to toxic substances, and some drugs, including acetaminophen, levodopa, and penicillin.
• Unexplained anemia. About 20 percent of all cases of anemia in older adults have no apparent cause. Plausible explanations include increased inflammation in the body or low testosterone levels. About 5 to 15 percent of older patients with unexplained anemia are later diagnosed with myelodysplastic syndrome, an unusual  bone marrow disorder that often progresses into leukemia. 

Treating anemia 

Treatment for anemia depends on its cause. Your doctor will treat the underlying cause. If anemia is a result of an iron deficiency, your doctor may suggest eating foods rich in iron, such as organ meats, seafood, spinach, beans, and prune juice. Your doctor may also recommend an iron supplement.

This article first appeared in the April 2018 issue of UC Berkeley Health After 50.

Also see The Good and Bad of Iron.