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CME

Anemia in Older Adults

General Information

Description

  • anemia in adults ≥ 65 years old that is typically mild (hemoglobin 10-12 g/dL), most commonly caused by nutritional deficiencies, chronic disease, and/or unexplained factors1,2,3

Definitions

  • World Health Organization (WHO) definition of anemia at sea level
    • hemoglobin < 13 g/dL (130 g/L) in men ≥ 15 years old
    • hemoglobin < 12 g/dL (120 g/L) in nonpregnant women ≥ 15 years old or adolescents aged 12-14 years
    • hemoglobin < 11.5 g/dL (115 g/L) in children aged 5-11 years
    • hemoglobin < 11 g/dL (110 g/L) in pregnant women, or children aged 6-59 months
    • Reference - WHO VMNIS 2011 PDF
  • lower limits of normal hemoglobin have been suggested based on ethnicity, gender, and age
    • 13.7 g/dL (137 g/L) in white men aged 20-59 years
    • 13.2 g/dL (132 g/L) in white men ≥ 60 years old
    • 12.2 g/dL (122 g/L) in white women ≥ 20 years old
    • 12.9 g/dL (129 g/L) in black men aged 20-59 years
    • 12.7 g/dL (127 g/L) in black men ≥ 60 years old
    • 11.5 g/dL (115 g/L) in black women ≥ 20 years old
    • Reference - 16189263Blood 2006 Mar 1;107(5):1747full-text

References

General references used

  1. Goodnough LT, Schrier SL. Evaluation and management of anemia in the elderly. Am J Hematol. 2014 Jan;89(1):88-96full-text
  2. Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015 Oct;52(4):261-9
  3. Merchant AA, Roy CN. Not so benign haematology: anaemia of the elderly. Br J Haematol. 2012 Jan;156(2):173-85full-text

Recommendation grading systems used

  • AABB (formerly the American Association of Blood Banks) grade methodology
    • quality of evidence
      • High - considerable confidence in the estimate of effect, future research is unlikely to change the estimate of the effect
      • Moderate - confidence that the estimate is close to the truth, further research is likely to have an important effect on confidence in the estimate and may change the estimate of the effect
      • Low - confidence in the effect is limited, true effect may differ substantially from the estimate, and further research is likely to have an important effect on confidence in the estimate of the effect and is likely to change the estimate
      • Very low - little confidence in the effect estimate
    • strength of recommendations
      • Strong - judgment that most well informed people will make the same choice
      • Weak - judgment that a majority of well-informed people will make the same choice, but a substantial minority will not
      • Uncertain - no specific recommendation for or against interventions
    • Reference - AABB guideline on red blood cell transfusion thresholds and storage (cxh119557120pmdc27732721pJAMA 2016 Nov 15;316(19):2025)
  • Eastern Association for the Surgery of Trauma/American College of Critical Care Medicine (EAST/ACCM) levels of evidence
    • Level I - evidence from ≥ properly randomized controlled trial (RCT)
    • Level II - evidence from well-designed controlled trials without randomization, cohort or case-control analytic studies, preferably from ≥ center, or research or evidence obtained from comparisons between times or places with or without the intervention
    • Level III - opinions based on clinical experience, descriptive studies, or reports of expert committees
    • Not applicable - opinions about issues that cannot be evaluated using accepted study designs
    • Reference - ACCM/EAST clinical practice guideline on red blood cell transfusion in adult trauma and critical care (19773646Crit Care Med 2009 Dec;37(12):3124)
  • National Comprehensive Cancer Network (NCCN) categories of evidence and consensus
    • Category 1 - based on high-level evidence, there is uniform NCCN consensus that intervention is appropriate
    • Category 2A - based on lower-level evidence, there is uniform NCCN consensus that intervention is appropriate
    • Category 2B - based on lower-level evidence, there is NCCN consensus that intervention is appropriate
    • Category 3 - based on any level of evidence, there is major NCCN disagreement that intervention is appropriate
    • Reference - NCCN Categories of Evidence and Consensus

Synthesized Recommendation Grading System for DynaMed Content

  • The DynaMed Team systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making (see 7-Step Evidence-Based Methodology).
  • Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline(s), and allow users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence.
  • In DynaMed content, we synthesize the current evidence, current guidelines from leading authorities, and clinical expertise to provide recommendations to support clinical decision-making in the Overview & Recommendations section.
  • We use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to classify synthesized recommendations as Strong or Weak.
    • Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
    • Weak recommendations are used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences (benefits and harms). Weak recommendations are used when clinicians disagree in judgments of relative benefit and harm, or have limited confidence in their judgments. Weak recommendations are also used when the range of patient values and preferences suggests that informed patients are likely to make different choices.
  • DynaMed synthesized recommendations (in the Overview & Recommendations section) are determined with a systematic methodology:
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      • Panel members will make Strong recommendations if and only if there is consistent agreement in a high confidence in the likelihood that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. Panel members will make Weak recommendations if there is limited confidence (or inconsistent assessment or dissenting opinions) that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. No recommendation will be made if there is insufficient confidence to make a recommendation.
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DynaMed Editorial Process

  • DynaMed topics are created and maintained by the DynaMed Editorial Team and Process.
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Special acknowledgements

  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Recommendations Editors provide explicit review of Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading."
    Deputy Editors oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T909408, Anemia in Older Adults; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T909408. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

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