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Anæmi hos ældre
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Anæmi
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Afvigelser mellem hæmoglobinkoncentration og hæmoglobinmasse
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WHO classification of anemia in the elderly (> 65 year)
  •   Men:  Hb < 13 g/dl  (8,06 mmol/l)
  • Women: Hb < 12 g/dl  (7,44 mmol/l)
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Hemoglobin range in the Elderly
  • Sex and Age Group (Total 292 pts) Hemoglobin (g/dl)
  • Males
  • All ages 16,00 +/- 1,96
  • 65-72 (n = 45) 14,5 +/- 2,53 *
  • 73-80 (n = 34) 13,66 +/- 3,85 *
  • 81-88  (n = 21) 13,83 +/- 3,89 *
  • 89-96 (n = 6) 14,42 +/- 3,63


  • Females
  • All ages 14,00 +/- 1,96
  • 65-72 (n=64) 13,74 +/- 3,02
  • 73-80 (n = 66) 13,51 +/- 2,80 *
  • 81-88 (n = 45) 12,74 +/- 2,65 *
  • 89-100 (n = 11) 12,96 +/- 4,47
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Serum Erythropoietin and Aging
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Percentages of persons 65 years and older who are anemic, by race/ethnicity and sex: NHANES III, phase 1 and 2, 1988-94
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Distribution of types of anemia in persons 65 years and older, United States: NHANES III, phase 2, 1991-1994
  • With nutrient deficiency
  •      No. In the United States                 Type, %              All Anemia %


  • Iron only 467000 48,3 6,6
  • Folate only 181000 18,8 6,4
  • B12 only   56000 5,8 2,0
  • Iron with folate or B12 or both 95.000 9,9 3,4
  • Total 965000 100 34,3


  • Without nutrient deficiency


  • Renal insufficiency only 230000 12,4 8,2
  • ACI only 554000 30 19,7
  • Renal  insufficiency and ACI 120000 6,5 4,3
  • Unexplained anemia 945000 51,1 33,6
  • Total 1849000 100 65,7


  • Total, all anemia 2814000 NA 100I
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Anæmi hos ældre
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Serum erythropoietin
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Anæmi hos ældre
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Anemia in the Elderly

Kikuchi et al. Five-Year Survival of Older People with Anemia: Variation with Hemoglobin Concentration. Journal of the American Geriatrics Society. 49: 1226-28; 2001
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Anemia in the Elderly
Wilkenson TJ & Warren MR. What is the prognosis of mild normocytic anaemia in older people. Int Med J 33: 14-17; 2003.
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Anemia in Elderly
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Distribution of types of anemia in persons 65 years and older, United States: NHANES III, phase 2, 1991-1994
  • With nutrient deficiency
  •      No. In the United States                 Type, %              All Anemia %


  • Iron only 467000 48,3 6,6
  • Folate only 181000 18,8 6,4
  • B12 only   56000 5,8 2,0
  • Iron with folate or B12 or both 95.000 9,9 3,4
  • Total 965000 100 34,3


  • Without nutrient deficiency


  • Renal insufficiency only 230000 12,4 8,2
  • ACI only 554000 30 19,7
  • Renal  insufficiency and ACI 120000 6,5 4,3
  • Unexplained anemia 945000 51,1 33,6
  • Total 1849000 100 65,7


  • Total, all anemia 2814000 NA 100I
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Anæmi hos ældre
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Iron balance
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Jernmangelanæmi
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Jernmangel
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Sideropeni


  • Serum ferritin < 15 mg/l  =  jernmangel
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Sensitivity and Specificity of Ferritin Values in Iron Deficiency Anemia
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Serum Ferritin
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Evaluation of the Gastrointestinal Tract in Patients with Iron Deficiency Anemia
  • Procedure and lesion     No of Patients
  • Colonoscopy
  • Colon cancer 11
  • Polyp 5
  • Vascular ectasia 5
  • Colitis 2
  • Cecal ulcer 2
  • Parasitic infestation 1
  • Total 26
  • Esophagogastroduedenoscopy
  • Duodenal ulcer 11
  • Esophagitis 6
  • Gastritis 6
  • Gastric ulcer 5
  • Vascular ectasia 3
  • Anastomic ulcer 3
  • Gastric cancer 1
  • Other 2
  • Total 37


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Jernmangel
  • Intravenøs jern er indiceret ved:
  • Dårlig absorption
  • Intolerans overfor behandlingen
  • Manglende kooperation


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Anæmi hos ældre
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Anæmi ved inflammation
  • Definition:
  • The anemia of chronic disorders may be defined as that anemia associated with chronic infections, inflammatory, traumatic and neoplastic illness and with characteristic disturbance of iron metabolism (GR Lee, 1983)


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Anæmi ved inflammation
  • Karakteristika:
  • Let til moderat anæmi (Hb > 5,4 mmol/l)
  • MCV og MCHC oftest normale, men kan være let nedsatte
  • S-jern nedsat og s-transferrin normalt trods normale jerndepoter
  • Udvikles fuldt inden for 4-6 uger.
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Anemia in Cancer
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Serum transferrin receptor
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Serum transferrin recepor
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EPO treatment in Cancer Anemia
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EPO treatment in Cancer Anemia
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Anæmi hos ældre
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Anæmi hos ældre
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Anæmi
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Anæmi
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Anæmi
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