Impact of anemia on mortality, cognition, and function in community-dwelling elderly.

PURPOSE: To explore the impact of varying hemoglobin levels on mortality, function, and cognition in a representative population of older persons. METHODS: Participants in this prospective cohort study included 1 744 men and women, aged 71 years or older, from a random household sample living in Durham and surrounding counties in North Carolina. Hemoglobin levels were obtained from participants at baseline in 1992. Functional status was measured at the 4-year follow-up interview using Katz and instrumental activities of daily living. Cognition was measured using the Short Portable Mental Status Questionnaire (SPMSQ). Death was determined by search of the National Death Index, and all deaths through 2000 are included. RESULTS: Using World Health Organization (WHO) criteria, the prevalence of anemia was 24%. There was a strong racial difference with an odds ratio, adjusted for age, education, estimated glomerular filtration rate and comorbidity of 3.0 (95% CI, 2.3-3.9) in African Americans compared with Caucasians. The risk ratio for 8-year mortality was 1.7 (95% CI, 1.5-2.0) for anemic subjects (P = .0001) and did not differ by sex or race. Anemia was strongly associated with poorer physical function (P = .0001) and cognitive function (P = .0001), and predicted decreases in both over a 4-year period. CONCLUSIONS: In an elderly community-based population, anemia is more prevalent in African Americans and is independently associated with increased mortality over 8 years for both races and sexes. Anemia also is a risk factor for functional and cognitive decrease.

Anemia is an independent predictor of mortality after percutaneous coronary intervention.

OBJECTIVES: The aim of the present study was to assess whether anemia is a marker of increased risk during interventional procedure and poor midterm survival after percutaneous coronary intervention (PCI). BACKGROUND: Anemia is associated with increased risk of mortality in patients with heart failure and myocardial infarction (MI). METHODS: We examined the outcomes of 6,116 consecutive PCI patients based on the hemoglobin (Hb) value before the interventional procedure. Patients were divided into three groups based on the baseline Hb level (g/l): Hb <10 = severe anemia; Hb 10 to 12 = mild anemia; Hb >12 = no anemia. RESULTS: The presence of anemia is associated with higher 30-day major adverse cardiac events, post-PCI peak troponin and creatine kinase-MB fraction, and a longer length of stay. After controlling for multiple covariates, significant difference in one-year survival was noted in the anemic groups compared with no anemia group (adjusted hazard ratio for Hb 10 to 12: 1.5 [95% confidence interval 1.3 to 1.8]; for Hb <10: 1.8 [95% confidence interval 1.3 to 2.3]; p = 0.004.) This adverse effect of anemia on survival was noted in all three presenting clinical syndromes (stable angina, unstable angina, and MI). CONCLUSIONS: Anemia is an independent predictor of mortality after PCI and is associated with higher short-term adverse procedural events.

Iron status markers in patients with small cell carcinoma of the lung. Relation to survival.

A longitudinal study of iron status markers (haemoglobin (Hb), serum (S-) iron, S-transferrin, transferrin saturation, S-ferritin) was performed in 31 chemotherapy treated patients with small cell lung cancer. At discovery, eight patients were anaemic (Hb less than 121 g l-1). Hb, S-iron and transferrin saturation were lower (P less than 0.01), and S-ferritin higher (P less than 0.01) than in healthy subjects. Chemotherapy induced an immediate fall in Hb (P less than 0.003), increase in S-iron (P less than 0.003) and transferrin saturation (P less than 0.001). Later in the disease a fall in S-transferrin (P less than 0.006) and an increase in S-ferritin (P less than 0.02) occurred. Thirty patients died during the 2 years observation. S-ferritin at discovery was correlated to performance status score (r = 0.57, P = 0.01) and to survival (r = -0.63, P less than 0.0002). Patients with S-ferritin less than or equal to 400 micrograms l-1 (n = 13) had longer survival than those with S-ferritin greater than 400 micrograms l-1 (n = 18) (P = 0.004).

Pernicious anaemia in the textile industry.

The objective was to examine whether the observed excess mortality from anaemia in textile and clothing workers was associated with any specific anaemia type or occupational activity. The design was a death certificate based case-control study of textile and clothing workers who died in England and Wales in the years surrounding the decennial censuses of 1961, 1971, and 1981. The main outcome measures were type of anaemia, place of residence, place of birth, and occupation. The frequency of the different types of anaemia in textile and clothing workers differed from that of England and Wales with relatively more deaths from pernicious anaemia than in the country as a whole (74 observed v 55 expected deaths). Within the industry, those whose death was attributed to pernicious anaemia were more than twice as likely as other textile and clothing workers to have worked in textile mills (odds ratio = 2.4, 95% confidence interval 1.4-4.2). These results could not be explained by age, sex, place of residence, or place of birth, and review of the death certificates did not suggest that pernicious anaemia as a cause of death had been recorded in error. Historical support for the finding was found in the Registrar General's 1931 decennial supplement on occupational mortality, in which the standardised mortality ratio from pernicious anaemia in male textile mill workers was estimated to be twice that of the general population. In conclusion, occupational factors, specifically work in textile mills, could be implicated in the pathogenesis of pernicious anaemia. The aetiology of this disease is not well understood and further study of pernicious anaemia in textile mill workers is required.

Severe iron deficiency anemia.

Severe iron deficiency anemia remains a continuing major health hazard among inner city children in Los Angeles. Over a 24-month period, 60 children in whom hemoglobin values were below 7 grams per dl were admitted to hospital; 11 (18 percent) of them were in overt congestive heart failure. Contrary to the popular conceptions, two thirds of the anemic children were undernourished, approximating the 16th percentile for weight on the Iowa growth chart, and the frequency of premature birth was not greater than in the general population. There were no deaths in this series. A management protocol which included partial exchange transfusion of children in congestive heart failure and supportive transfusion for children with hemoglobin levels below 5 grams per dl was employed.