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Understanding Anemia By Susan Kao, MD

Apr 03, 2017 02:24PM ● By Elena Hutslar

Susan Kao, MD

Anemia in the older adult can be a challenging diagnosis to treat as up to 20-30% of patients may have unexplained anemia, even after a thorough workup, and a good proportion of patients have multiple causes for their anemia. It’s important to address the cause, and in many cases it’s important to correct because it can potentially cause a decline in one’s physical and mental functioning. Studies have shown an association between increased falls and frailty as well as decreased attention span and executive function with even mild anemia. 

When we do a workup for anemia, our initial goal is to find an etiology that we can correct.  We first rule out nutritional deficiencies such as iron, folate, or B12 deficiency.  These account for about one-third of anemia in older adults.  Another one-third of anemia is due to either chronic kidney disease or other chronic or inflammatory disorders such as diabetes, autoimmune disorders, acute or chronic infections, or underlying cancer. Patients with otherwise unexplained anemia may have a bone marrow disorder or defect in bone marrow function.

If iron deficiency has been identified as the cause of the anemia, it’s important to look for a site of blood loss, which usually involves evaluating the gastrointestinal tract through upper and lower endoscopies, which can identify malignant lesions as well as benign lesions like ulcers, polyps, diverticuli, hemorrhoids, and vascular malformations.  If there is no clear site of blood loss, then we may look for reasons for poor absorption of iron such as poor dietary intake or poor absorption of iron due to celiac disease.

Even if we cannot find an underlying cause, we can still treat and potentially improve the patient’s symptoms.  We can either give red blood cell transfusions, which carries some risks but can be of benefit, especially in those with underlying cardiac disease. Or we can potentially use injectable medications that stimulate the bone marrow to make more red blood cells. 

Part of the Hippocratic Oath I took when I became a doctor was to not just treat the disease but to care for the sick person. This includes palliation of symptoms and doing no harm.  I hope to be a guide and a partner with my patients in their medical journey. 

Dr. Kao is board certified in internal medicine, hematology and medical oncology and practices with Diablo Valley Oncology & Hematology Medical Group. Dr. Kao is accepting new patients at offices in Pleasant Hill and Rossmoor/Walnut Creek.  To contact Dr. Kao, please call 925-677-5041.