In a large prospective, longitudinal study with more than 1 000 people born in the beginning of the 20th century (the H70-study) the focus has been to examine the health and quality of life of elderly people. The participants were examined eight times over 18 years, beginning at age 70. Since the same persons were followed through the years, they became their own controls. This is an advantage when it comes to finding out what a normal Hb value is for that person, and what is not.

Herman Nilsson-Ehle and colleagues have found that the Hb values of elderly people do not decrease dramatically as a consequence of age. In healthy men, Hb declines by 0.9 -1.0 g/dL (7%) between the ages of 70 and 88 years. In healthy women however, the Hb value stays at the same level throughout life. Each individual has their own biologically normal Hb. Therefore, it is important to compare a patient’s Hb value to earlier values to determine if a change has occurred.

The important thing, according to Herman Nilsson-Ehle, is to further investigate dramatic decreases in a patient’s Hb value since there is always a reason. One common cause for a drop in Hb is inflammation, such as rheumatoid arthritis, a general infection or an inflammation of the bone marrow. Bleeding from sources such as intestinal ulcers, adenoids or cancerous tumors may also cause anemia. Other causes are deficiencies of vitamin B12, folic acid or iron, or a shortened life-cycle of blood cells which can be caused by some medications or by auto-immune processes.

“In our studies we found a cause for the anemia in nearly all, if not all cases. Once the type of anemia is known, it is possible to give the correct treatment. Low Hb values should be treated, even if the patient may be too sick or frail to undergo investigation regarding the underlying cause. Even if it may seem difficult to find the reason for the low Hb of say a woman of 80+ it is important to do so. If she falls because of dizziness that is when it gets really difficult. Since a low Hb is an indicator that something is wrong, and since a Hb-test is both very simple to perform and is done at low cost, it should definitely be done”, says Herman Nilsson-Ehle.

Herman Nilsson-Ehle, MD and PhD, is an associate professor at the Section of

Hematology and Coagulation at the Sahlgrenska University Hospital in Göteborg, Sweden. He has 30 years of experience treating patients suffering

from anemia.