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How to cite this article: Mzabi A, Marrackchi W, Alaya Z, Ben Fredj F, Anoun J, Rezgui, Kechrid Laouani C . Epidemiological, Clinical, Biological
and Etiological Aspects of Hypochromic Microcytic Anemia in Aged Persons. OAJ Gerontol & Geriatric Med. 2018; 4(4): 555643. DOI: 10.19080/OAJGGM.2018.04.555643
Purpose: Hypochromic microcytic anemia is a common hematological abnormality in the older people. The aim of this study is to determine the epidemiological, clinical and biological characteristics and causes of the hypochromic microcytic anemia in elderly patients.
Patients and Methods: We performed a retrospective study of 124 patients aged 65 years and older who were hospitalized for hypochromic microcytic anemia in the internal Medicine Department.
Result: Sixty nine women and fifty five men were included in the study. The mean age was 75 years and 4 months. Iron deficiency anemia was diagnosed in 72 cases (58.1%). A gastrointestinal bleeding was the most common etiology (59.7 %). Anemia was poorly tolerated in 30.5 % of cases. Serumiron and ferritin were low in the majority of cases. An inflammatory origin of anemia diagnosed in 52 cases (41.9%). Cancers and thromboembolic causes were the most frequent etiology in these cases. The multifactorial anemia was in 15 of the patients (12%).
Conclusion: A comprehensive history, physical examination, and laboratory evaluation are required for an elderly person found to have anemia.
Aging is the set of organic, physiological and psychological changes that occur with advancing age. The World Health Organization (WHO) defines the elderly subject (ES) as a person whose age is greater than or equal to 65 years old . Aging is related to several health problems affecting different organs and making the geriatric pathology varied and difficult to manage. These problems include anemia, which remains the most common hematologic problem in geriatrics . Literature data shows the increase in the prevalence of anemia with age and especially after 65 years old. In fact, 11% of men and 10.2% of women over 65 are anemic [3,4]. Hypochromic Microcytic Anemia (HMA) is the most common type in ES. The objective of this work is to determine, the epidemiological, clinical and biological profile according to the etiology of the HMA of elderly patients hospitalized in the department of internal medicine of the University Hospital Center (UHC) Sahloul during the period from January 1999 to January 2015.
A cross-sectional study including patients whose age was greater than or equal to 65 years old, hospitalized for HMA in the internal medicine department of UHC Sahloul de Sousse during the study period from January 1999 to January 2015 regardless of their medical and surgical history. The data was collected from patients’ medical records using a form for this
study, which included epidemiological, clinical, biological and etiological data. In our study, anemia is defined according to the WHO by a rate of hemoglobin (Hb) less than 13g/dl in men and 12 g/dl in women . Anemia is called microcytic hypochromia if the Mean Hemoglobin Corpuscular content (MHCC) and the Mean Corpuscular Volume (MCV) are respectively less than 27 pg and 80 fl / l.
Between January 1999 and January 2015, the total number of elderly, anemic subjects hospitalized in the internal medicine department of CHU Sahloul; was 625. Among them, 124 patients (19.8%) had an HMA. It was 7.5% of all ES hospitalization grounds in our department. The average age of patients was 75.4 years old (65-97 years old). The most common age range was between 76 and 80 years (60%). Our study included 55 men (44.4%) and 69 women (55.6%), the sex ratio was 0.8.
Iron Deficiency Anemia (IDA) was observed in 72 patients (58% of cases). Among them, there were 42 women (58%) and 30 men (42%); the sex ratio was 0.76. Anemic syndrome was observed in 96% of cases. The most common clinical signs were cutaneo-mucous pallor (84.7% of cases) and asthenia (66.7% of cases). The most common signs of intolerance for anemia were poorly tolerated tachycardia (37.5% of cases) followed by rest dyspnea (19.4% of cases) and cardiac arrhythmias (19.4%).
Anemia was poorly tolerated in 30.5% of patients. Of the latter,
18 had a history of cardiorespiratory pathology (Table 1).
summarizes the biological characteristics of patients with IDA.
Blood spoliation was the most common cause of IDA (69.4% of
AF cases). The different etiologies are grouped in Table 2.
Anemia was of inflammatory origin in 52 cases (41.9% of
microcytic hypochromic anemias). The average age of patients
with inflammatory anemia was 76 years with extremes of 65 and
97 years. Anemic syndrome was present in 7 patients (13.7% of
cases). The most common signs were cutaneo-mucous pallor (6
cases) and asthenia (5 cases). Table 1 summarizes the biological
characteristics of IA patients. An etiology of IA was noted in 43
cases (82.7% of cases).
Our study has established the clinical, biological and
epidemiological profile of anemia in elderly patients
hospitalized for a period of 15 years. This period represents
a strong point of the study, making it possible to list the main
types of anemia as well as their clinical, biological and etiological
characteristics. However, there are some limitations to be noted
such as iron self-medication before hospitalization, which can
influence the results in some cases. Anemia remains the most
common hematologic problem in geriatrics and is responsible
for significant morbidity and mortality . The evaluation of
the frequency of anemia in the elderly population varies widely
according to the studies. This variability can be explained by
the heterogeneity of the populations studied in terms of age,
social conditions, co-morbidities and ethnicities. Added to this,
the variability is also related to the definition of anemia in ES
[1,2]. In our series, the number of ES with an HMA was 124
cases, which is 7.5%. Several studies . have shown that the
frequency of HMA increases proportionally with age, especially
after age. In a study conducted in 2009, including 126 patients
over the age of 65 with an HMA; Patiakas found an average age
of 78 years and 10 months . In addition, several authors have
described the action of testosterone on hematopoietic organs.
Indeed, testosterone exerts a stimulating effect on normal
erythropoiesis by acting either directly on the stem cells, or
indirectly by stimulating the production of erythropoietin .
In our series, there was a female predominance (69 women:
55.6%). Iron deficiency anemia is the main cause of deficiency
anemia in ES . The incidence of IDA in ES was 3.5 to 5.3% in
Anglo-Saxon series .
In our study, the frequency of IDA was 11.2% in relation to
all the etiologies of SA anemias. Our population was relatively
young compared to those described in the literature. Indeed,
in a French study conducted in 2011 . the average age of
patients with IDA was 79.5 years. In addition, a predominance
of women has been noted in our series. Regarding clinical signs,
the anemic syndrome may be difficult to diagnose in some cases,
especially when anemia gradually appears with better tolerance
even at a very advanced stage. In our study, cutaneous-mucous
pallor was the most frequently observed sign (84.7% of cases)
followed by asthenia (66.7% of cases). In the Chebbi et al. 
Series, the most common clinical signs were cutaneo-mucous
pallor and asthenia . The coexistence of other pathologies
plays an important role in the tolerance of anemia. The latter
may be a decompensation factor for another cardiovascular,
neurovascular or neuropsychiatric pathology . In our study,
anemia was poorly tolerated in 30.5% of IDA cases. Regarding
biological characteristics, the average Hb level was 7.8 g / dl in
our study. In a series including 104 elderly anemic subjects .
the mean value of Hb was slightly higher.
The number of reticulocytes is important for assessing the
regenerative or non-regenerative nature of anemia . The
determination of serum ferritin is the best μ indicator of iron
deficiency. μ Szymanowicz . defines hyperreninemia as
serotonemia less than 30 g/l in men and less than 20g/l in women.
In ES, almost all iron deficiency types of anemia are associated
with chronic bleeding, most often digestive. Other bleeds may
be less frequently involved such as menu-metrorrhagia, gross
hematuria, abundant and recurrent epistaxis . In our
series, digestive bleeding was the most common cause of blood
spoliation (86% of cases). It was essentially related to a peptic
ulcer. Gastroduodenal ulcers and gastritis accounted for the
most common etiologies of digestive bleeding in the Chebbi et
al.  and in that of Serraj et al.  In the literature, chronic
bleeding at the origin of IDA in ES is rarely extra digestive. In our
series, extra digestive bleeding was associated with gynecologic
bleeding (3 cases), hematuria (one case) and recurrent epistaxis
(one case). Iron deficiency anemia due to lack of iron absorption
is most often related to gastrectomy’s, pelvic resections and
more rarely to geophagy. Nutritional deficiency of nutritional
origin remains rare in the elderly .
Inflammation is the leading cause of anemia in ES [15,16].
Its frequency with respect to all anemia varies from 11.1% to
43.3% of anemia [3,4]. In our study, anemia was of inflammatory
origin in 41.9% of cases. IA is well tolerated, and the functional
signs of anemia are uncommon except in advanced forms or in
cases of very severe causal pathology. It is initially normocytic
norm chromium. At a more advanced stage, during a prolonged
inflammatory syndrome, it becomes hypochromic microcytic
. In our study, the MCV ranged from 70.07 to 79.9 fl with
an average of 74.7%. Anemia is usually moderate; the Hb level
is inversely correlated with the intensity and duration of the
inflammatory syndrome . In our series, the average Hb
level was 9.97g / dl. In inflammatory anemia, reticulocytes can
be normal or decreased . The decline in the serum iron is
moderate and early onset during the was IA . Serotonemia
μ mol/lumen is usually ferritin level sated were during
inflammatory .μg/l.Incurrentanemiapractice,.outstudy, the mean
serum iron elevated sedimentation rate (SR), C-reactive protein
(CRP) and fibrinogen are sufficient to establish the diagnosis of the inflammatory syndrome that accompanies IA in ES .
In our study, the etiologies of IA were dominated by neoplastic
causes (15 cases) followed by thromboembolic causes (11
cases). Concerning neoplastic pathology, similar results were
observed in the Khaldun series .
The HMA is responsible for significant morbidity and
mortality in the ES. IDA remains the most common etiology. It
is essentially related to digestive bleeding. The clinical picture
is dominated by cutaneo-mucous pallor and asthenia. The IA
holds the second place. The clinical picture is dominated by
signs of causal pathology. The neoplastic cause remains the most
frequent cause of IA. HMA can be as multifactorial. A martial
assessment as well as an inflammatory assessment remain
fundamental to guide the etiological investigation.