Gary Sergott always felt tired. “I would get tired, short of breath, a kind of malaise,” he said. He was cold even on hot days and looked pale with dark circles under his eyes.
His illness was not mysterious. As a retired nurse anesthesiologist, Sergott knew that he had anemia, a shortage of red blood cells. In his case it was the result of a hereditary state that caused almost daily bloody nose and his hemoglobin exhausted, the protein in red blood cells that deliver oxygen in the body.
But by consulting doctors about his fatigue, he discovered that many did not know how to help. They advised Sergott, who lives in Westminster, Maryland, to take iron tablets, usually the first -line treatment for anemia.
But like many older people, he found a daily regime of four to six tablets difficult to tolerate. Some patients who complain iron about severe constipation or stomach cramps. Sergott felt “always nauseous”. And iron tablets don’t always work.
After almost 15 years he found a solution. Michael Auerbach, a hematologist and an oncologist who is co-director of the center for cancer and blood disorders in Baltimore, suggested that Sergott IJzer receives intravenously instead of orally.
Now Sergott, 78, gets an hour -long infusion when his hemoglobin levels and other markers demonstrate that he needs one, usually three times a year. “It’s like filling the gas tank,” he said. His symptoms go behind and “I feel great.”
His story, however, reflects the frequent dismissal of a common condition, one that can not only reduce the quality of life of older adults, but can also lead to serious health consequences, including falling, fractures and stay in the hospital.
The symptoms of anemia – fatigue, headache, leg cramps, cold, reduced ability to exercise, brain mist – are often attributed to aging itself, William Ershler, a hematologist and researcher. (Some people with anemia remain asymptomatic.)
“People say:” I feel weak, but everyone my age feels weak, “said Erhler.
Although the hemoglobin levels are probably included in the files of their patients, as part of the entire blood count, or CBC, routinely arranged during medical visits, doctors often recognize anemia.
“The patients come to the clinic and get the blood tests, and nothing happens,” he said.
Anemia affects 12.5% of people over 60, according to the Most recent survey data From the National Health and Nutrition Examination Survey, and the speed rises afterwards.
But that can be an underestimation.
In a study published in the Journal of the American Geriatrics Society, Erhler and his colleagues examined the electronic health files of nearly 2,000 outpatient clinics of more than 65 at Inova, the large health system based in Noord -Virginia, where he recently retired.
Based on the results of the blood tests, the prevalence of anemia was much higher: over 1 in 5 patients was anemicWith hemoglobin levels under normal as defined by the World Health Organization.
Yet only about a third of those patients had documented anemia well in their medical graphs.
Anemia deserves our attention, but it doesn’t always understand, “said George Kuchel, a geriatricist at the University of Connecticut, who was not surprised by the findings.
That is partly because anemia has so many causes, some to treat more than others. In perhaps a third of the cases it stems from a nutritional deficiency – Usually a lack of ironBut sometimes of vitamin B12 or folic acid (folic acid mentioned in synthetic form).
Older people may have a reduced appetite or struggle to shop for food and meals. But anemia can also follow blood loss due to ulcers, polyps, diabetes and other causes of internal bleeding.
Surgery can also lead to iron deficiency. Mary Dagold, 83, a retired librarian in Pikesville, Maryland, underwent three abdominal operations in 2019. She then remained bedridden for weeks and needed a food tube for months. Even after she is healed, “the anemia did not go away,” she said.
She remembers that she constantly felt exhausted. “And I knew I didn’t think as I usually think,” she added. “I couldn’t read a novel.” Her doctor for primary care and Auerbach both advised that oral iron would probably not help.
Iron tablets, without a prescription, are cheap. Intravenous iron, which are prescribed wider, can cost $ 350 to $ 2,400 per infusion, depending on the formulation, Auerbach said.
Some patients find a single dose sufficient, while others need regular treatment. Medicare covers it when tablets are difficult to tolerate or not effective.
For Dagold, an intravenous iron infusion of 25 minutes has made a surprising difference every five weeks. “It takes a few days, and then you feel good enough to take on your daily life,” she said. She has returned to her water Aerobics class four days a week.
In other cases, anemia stems from chronic disorders such as heart disease, kidney failure, bone parss or inflammatory bowel diseases.
“These people don’t miss iron, but they can’t process it to make red blood cells,” said Kuchel. Because iron supplements will not be effective, doctors try to tackle the anemia by treating the underlying diseases of patients.
Another reason to pay attention: “Loss of iron can be the first harbinger of colon cancer and stomach cancer,” Kuchel noted.
In about a third of patients, however, anemia remains frustratingly inexplicable. “We did everything and we have no idea what it causes,” he said.
Learning more about the causes and treatments of Anemia can prevent a lot of misery on the road. In addition to the association with trial and fractures, anemia “can increase the severity of chronic diseases – heart, lung, kidney, liver,” said Auerbach. “If it is really serious and hemoglobin goes to life -threatening levels, this can cause a heart attack or stroke.”
However, one of the strangers is whether the early treatment of anemia and the repair of normal hemoglobin will prevent later diseases. Still, “is happening in this area,” said Erhler, pointing to a National Institute on Aging Workshop on inexplicable anemia held last year.
The American Society of Hematology has appointed a committee as Diagnosing and treating iron deficiency And plans to publish new guidelines next year. The Iron Consortium of Oregon Health & Science University has convened an international panel to manage iron deficiency and recently published her recommendations In the Hematology of Lancet.
In the meantime, many older patients can gain access to their CBC results and therefore their hemoglobin levels. The World Health Organization defines 13 grams of hemoglobin per deciliter as normal for men, and 12 for non -pregnant women (although some hematologists claim that those thresholds are too low).
Healthcare providers ask about hemoglobin and iron levels, or the use of a patient portal to check the figures themselves, can help patients send conversations with their doctors away from fatigue or other symptoms as inevitable results of aging.
Perhaps drawing anemia, and maybe it can be treated.
“Chances are that you have had a CBC in the last six months or a year,” said Kuchel. “If your hemoglobin is okay, great.”
But he added: “If it really falls outside the normal limits, or it has changed compared to a year ago, you must ask questions.”
The new age is produced by a partnership with The New York Times.
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