Lack of Anemia Screening Leaves Older Patients More Vulnerable: Study

The study reveals a gap in health screening, with treatable causes of anemia like low B12, folate, and iron often overlooked.

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Anemia is a common yet stealthy condition with often overlooked or unnoticed symptoms. The condition can significantly affect one’s health and well-being, making early detection through regular screening critical for effective management and treatment.

However, a study from the University of Limerick School of Medicine in Ireland published in early 2024 found that physicians aren’t adequately screening for the condition. The retrospective cohort study, which included 112 ,181 adult patients, aged 18 years and older, found that 12 percent of patients had anemia—a higher figure than expected.

The study revealed the prevalence of anemia was significantly higher in women than men up until ages 55 to 59, at which point it was more prevalent in men. Anemia diagnoses considerably increased with age, reaching 33.4 percent for participants over 75 years of age, and the study found that “prevalence increased more rapidly with age in men than in women.”

Prevalence of anemia, iron, and vitamin deficiencies in the health system in the Republic of Ireland: a retrospective cohort study Conor Cian Clancy, Leonard D Browne, Robert Gilligan, Ophelia Blake, Austin G Stack https://doi.org/10.3399/BJGPO.2023.0126 Copyright © 2024, CC BY license material.

The study sheds light on an important gap in health care screening. Treatable causes of anemia, such as low vitamin B12, folate, and iron, were often overlooked and not tested for. Less than 20 percent of the anemic patients were screened for B12 and folic acid deficiencies, and only one-third of them were tested for an iron deficiency in their follow-up appointment at three months.

In the United States, the most recent data from the National Health and Nutrition Examination Survey found that more than 70 percent of iron-deficiency anemia cases are missed in pregnant women and children. An article published in 2022 in the American Journal of Public Health determined that the current U.S. guidelines on screening for anemia are outdated or inconclusive.

What Is Anemia?

According to the Mayo Clinic, anemia is when there aren’t enough healthy red blood cells in the blood, leading to the body’s tissues and organs not receiving enough oxygen. Hemoglobin is the part of the red blood cell that carries oxygen to tissues in the body. Iron is “an essential component of hemoglobin.”

Many factors, including nutritional deficiencies, chronic diseases, digestive disorders, or genetics, can cause anemia. Treatment options for anemia depend on the underlying cause. They may include dietary modifications, supplements, and other medical interventions for severe cases.

Types and Causes of Anemia

There are many variations of anemia. The most common variations and causes of anemia include:

Iron Deficiency

This is the most common type of anemia caused by a lack of iron in the body, which is necessary for producing hemoglobin. It is usually a result of heavy blood loss, not consuming enough iron-rich foods, or an inability to absorb iron from food. Acute or chronic blood loss from sources such as heavy menstrual periods, gastrointestinal bleeding, or trauma can lead to this type of anemia.

Vitamin Deficiency

Vitamin deficiency anemia is caused by deficiencies in essential vitamins, which are necessary to produce healthy red blood cells:

• Vitamin B12 is necessary for making red blood cells.
• Folate is also vital for the formation of red blood cells.
• Vitamin B6 deficiency is less common, but low levels can affect hemoglobin production.

Hemolytic Anemias

This type of anemia occurs when red blood cells are destroyed faster than they are produced, leading to a shortage of red blood cells.

Aplastic

Aplastic anemia is rare but serious. It occurs when the body fails to produce enough red blood cells due to damage or failure of the bone marrow.

Sickle cell

Sickle cell is a genetic form of anemia in which red blood cells become rigid and sticky, leading to blood vessel blockage and reduced oxygen delivery to tissues.

Chronic diseases

Certain chronic conditions, such as kidney disease, cancer, and rheumatoid arthritis, can lead to anemia because of decreased production or increased destruction of red blood cells.

Pregnancy

Anemia can occur due to increased blood volume and the body’s need for extra iron to support the growing fetus.

Bone Marrow Disorders

Conditions that affect the bone marrow, such as leukemia or myelodysplastic syndromes, can lead to anemia by interfering with the production of red blood cells.

Several medications can cause anemia as a side effect. Some of these include:

• Chemotherapy drugs and cancer treatments, such as radiation and chemotherapy, can all contribute to anemia.
• Nonsteroidal anti-inflammatory drugs, including ibuprofen and aspirin, can lead to GI tract bleeding.
• Antibiotics, such as penicillin or cephalosporins, may lead to anemia in some cases.
• Anticonvulsants used to treat epilepsy are associated with anemia.
• ACE (angiotensin-converting enzyme) inhibitors used to treat and manage hypertension may lead to mild anemia.
• Antiretrovirals, a class of drugs used to treat HIV, are a risk factor for developing anemia.

Anemia at an Older Age

The study’s authors concluded that the burden of anemia in the health care system is especially consequential for older patients due to their increased vulnerability.

According to a study published in Blood, anemia is a risk factor for poorer cognitive function and mood, cardiovascular diseases, and insomnia, as well as more frequent—and longer—hospital stays. It is also associated with reduced executive function and performance. Low hemoglobin levels are also associated with a higher risk of falls and fractures, which are common among the elderly population. There’s also evidence that anemia serves as a marker for mortality.

Symptoms of Anemia

Physical symptoms of anemia include fatigue and weakness, shortness of breath, and an irregular heartbeat.

“Lack of oxygen in the blood can lead to persistent tiredness, and people may experience difficulty breathing even with mild exertion,“ Dr. Ramit Singh Sambyal, general physician and head of emergency medicine at Metro Hospitals & Hearts Institute, told The Epoch Times in an email. ”The heart may work harder to pump more oxygen-rich blood.”

Pale or yellowish skin due to reduced hemoglobin levels, cold hands and feet, and headaches are also common physical manifestations of anemia. Cognitive disturbances may include brain fog, concentration issues, lightheadedness, and dizziness. Mental disturbances may surface as mood changes and irritability.

Anemia due to low levels of vitamin B12 or folate may cause a sore tongue, cracks at the side of the mouth, and mouth ulcers. A deficiency of these vitamins may also lead to memory and vision issues, problems with balance and coordination, and numbness and tingling in the hands or feet.

Foods to Help Combat Anemia

According to the National Library of Medicine, when the underlying cause of anemia is a nutritional deficiency, simple dietary changes can help appease symptoms and ameliorate weaknesses. Iron-rich foods, emphasizing animal protein, should be incorporated to address iron deficiency.

“You need a bioavailable source of iron for it to be useful for your body,“ Dan Gallagher, a registered dietitian at Aegle Nutrition, told The Epoch Times in an email. ”Many forms of fortified iron aren’t very bioavailable, which means your body is going to struggle to utilize it.”

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Heme iron, found in animal products, is more easily absorbed by the body. Non-heme iron, found in plant-based foods such as lentils and beans, isn’t as easily absorbed. Pairing non-heme iron sources with vitamin C-rich foods, such as citrus or vegetables, can help with absorption.

Mr. Gallagher explained: “The best [high-iron food] is red meat. Red meat has the most bioavailable form of iron you can find, meaning your body will be able to use all the iron available in the meat.”

Certain beverages are best avoided while consuming iron-rich foods. Coffee and tea contain phytates that can inhibit absorption, as can calcium-rich drinks such as dairy milk. Preparing food in cast iron cookware is also a helpful way to fortify its iron content.

Importance of Anemia Screening, Early Detection

Undiagnosed and untreated anemia can hinder physical stamina and cognitive functions, among other serious complications, including multi-organ failure and even death.

“Anemia can lead to a rapid or irregular heartbeat, leading to more severe conditions like heart failure,“ Dr. Sambyal said. ”Severe anemia increases the risk of preterm delivery and low birth weight [in pregnancy], and chronic anemia can affect growth and cognitive development in children.”

Awareness of common risk factors, causes, and symptoms of anemia is a proactive step to maintaining overall health across all ages and populations. In addition to ensuring your physician screens for anemia, checking for nutritional deficiencies in vitamin B12, B6, and folate is also helpful.