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DOI: 10.1055/s-0041-103349
Anämie im Alter
Anaemia in the elderlyPublication History
Publication Date:
30 June 2016 (online)
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Zusammenfassung
Auch laborchemisch gering ausgeprägte Anämien führen bei älteren Menschen zu erheblichen Einschränkungen der Lebensqualität und erhöhen das Sterberisiko. Deshalb sollten gerade im Alter grundsätzlich auch leicht ausgeprägte Anämien diagnostisch abgeklärt werden. Bei über zwei Dritteln aller Anämien kann eine meist spezifisch behandelbare- Ursache für die Anämie gefunden werden.
Die Differenzialdiagnostik einer Anämie ist deutlich anspruchsvoller als bei jungen Menschen: bei alten Menschen bestehen häufig parallel mehrere Ursachen. Viele Routineparameter sind bei älteren Menschen verändert und damit für eine Anämiediagnostik nur eingeschränkt brauchbar. Zwei brauchbare Parameter zur laborchemischen Differenzierung von Anämieursachen im Alter sind der lösliche Transferrinrezeptor und das Hepcidin.
Die häufigste Ursache für eine Eisenmangelanämie im Alter ist ein Blutverlust über den Gastrointestinaltrakt. Viele – wie zum Beispiel Angiodysplasien – sind relativ einfach endoskopisch behandelbar. Deshalb gehört eine Sigmoido-Koloskopie bei älteren Menschen mit Eisenmangelanämie zur Standarddiagnostik, sofern keine Kontraindikationen bestehen.
Die Therapie der Anämie richtet sich nach der Ursache. Bei Eisenmangelanämie erfolgt zunächst eine orale Eisensubstitution. Sofern diese wegen Nebenwirkungen nicht toleriert wird oder der Hämoglobinanstieg ausbleibt – was bei älteren Menschen häufig der Fall ist- erfolgt die Eisensubstitution parenteral. Ein Folsäuremangel wird in der Regel oral, ein Vitamin-B12-Mangel in der Regel parenteral, vorzugsweise subkutan behandelt. Bei Anämie im Rahmen einer Niereninsuffizienz und bei Myelodysplastischen Syndromen können – neben der Behandlung der Grunderkrankung – erythrozytenstimulierende Faktoren zur Anwendung kommen.
Abstract
In the elderly, even mild anaemia leads to significantly decreased quality of life and reduced survival rate. Therefore even mild anaemias should be worked up especially in the elderly. More than 75 % of all anaemias have a specific and treatable cause.
Differential diagnosis of anaemia in the elderly is much more challenging compared to the differential diagnosis in younger patients: in older patients often more than one dysfunction is responsible for the anaemia simultaneously. Many routine laboratory parameters are changed by ageing and are therefore only of limited value for diagnosis of anaemia. Soluble transferinreceptor and hepcidin are two parameters feasible for differential diagnosis of the causes of anaemia in the elderly.
The most common cause of iron deficiency anaemia in the elderly is gastrointestinal bleeding. Many causes for gastrointestinal bleeding –like angiodysplasia of the colon – can readily be treated with endoscopic therapy. For this reason, colonoscopy is part of the standard workup for elderly patients with iron-deficient anaemia (IDA) if no contraindications exist.
Therapy of anaemia is based on the specific cause or the causes. In IDA, the first step other than causal treatment is to replace iron orally. If this is not tolerated because of side effects or does not lead to a sufficient rise in the haemoglobin level, intravenous iron replacement therapy is indicated. Folic acid deficiency is generally treated orally, whereas vitamin B12 deficiency is generally treated by the parenteral – preferably subcutaneous – route. In anaemia due to chronic renal failure and anaemia due to myelodysplastic syndromes, the underlying cause must be treated, furthermore erythropoiesis-stimulating agents can be indicated.
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