Unexplained anaemia in older persons is characterised by low erythropoietin and low levels of pro‐inflammatory markers
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Summary: 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 ≥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.
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The most frequent etiologies of anemia in elderly patients with CVD are nutritional deficiencies and chronic diseases, in particular renal insufficiency leading to EPO deficiency and chronic inflammation.
“In general, the most frequent etiologies of anemia in elderly patients with CVD are nutritional deficiencies (e.g., of iron, vitamin B12, and folic acid) and chronic diseases, in particular renal insufficiency [leading to EPO deficiency (56)] and chronic inflammation.”
From Red Blood Cell Function and Dysfunction: Redox Regulation, Nitric Oxide Metabolism, Anemia (2017) · cites this paper as [56]
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- Authors
- Ferrucci, L., Guralnik, J. M., Bandinelli, S., Semba, R. D., Lauretani, F., Corsi, A., Ruggiero, C., Ershler, W. B., & Longo, D. L.
- Affiliations
- National Institute on Aging (US)
- Associação Saúde da Família (BR)
- Johns Hopkins University (US)
- Agenzia Regionale di Sanità della Toscana (IT)
- University of Florence (IT)
- Corresponding author
- Ferrucci, Luigi
- ORCID
- Venue
- British Journal of Haematology
- Publisher
- Wiley
- Published
- 2007-03
- Volume
- 136
- Issue
- 6
- Pages
- 849-855
- ISSN
- 0007-1048 (ISSN-L)
- 1365-2141
- PMC
- PMC2669300
- OpenAlex
- W2092104238
- Cited by
- 149
- References
- 30
- Citations by year
- 2026: 3 · 2025: 7 · 2023: 11 · 2022: 2 · 2021: 5 · 2020: 3 · 2019: 6 · 2018: 6 · 2017: 9 · 2016: 7 · 2015: 11 · 2014: 11 · 2013: 3 · 2012: 11
- FWCI
- 8.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Haematology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Ministero della Salute (263 MD 9164 13, ICS 110.1/RS97.71, N01-AG-916413, 263 MD 821336, N01-AG-821336, 263 MD 9164, 110.1|RS97.71)
- National Institutes of Health (Z99 AG999999)
- National Institute on Aging (263 MD 9164, N01AG-821336, 263-MD-9164-13, 821336, N01[AG]916413, 263MD821336, R01AG027012)
- National Institute on Minority Health and Health Disparities (263-MD-916413, 263MD 821336, R01MD009164)
- Topics
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Emergency Medicine › Hematological disorders and diagnostics
- Keywords
- older adults, erythropoietin, pro-inflammatory markers, C-reactive protein, interleukin-6, iron deficiency anemia, anemia of chronic disease, chronic kidney disease, lymphocyte count, comorbidities
- MeSH terms
- Aged, Aging, Anemia, C-Reactive Protein, Cardiovascular Diseases, Diabetes Mellitus, Erythropoietin, Female, Health Surveys, Humans, Italy, Kidney Diseases, Male, Osteoarthritis, Parkinson Disease, Tumor Necrosis Factor-alpha, Biomarkers, Interleukin-6, Case-Control Studies, Lymphocyte Count, Inflammation Mediators, Stroke
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