Anemia at outpatient and hospital stages
Abstract. Anemia is one of the most common pathologies in patients of different age. The analysis of the incidence of different pathogenetic variants of anemia, discussion of the reasons for their late detection and insufficient treatment efficacy are aimed at improving the tactics of managing patients with anemia both at the outpatient and hospital stages.Larina V.N., Kudina E.V., Sheregova E.N., Zamyatin K.A., Polivanova A.E., Baykova N.A., Vavilov I.V., Baranova I.A.
The aim: to assess the incidence and severity of laboratory-confirmed anemia in patients observed at the outpatient and hospital stages.
Material and methods. A retrospective cross-sectional analysis of hemoglobin levels over the course of a year was performed using the continuous sampling method in the population (n = 260,000) aged 18 to 95 years attached to Diagnostical Clinical Center No. 1 of the Department of Healthcare of Moscow and in patients aged 19 to 96 years with anemia hospitalized in therapeutic department of the hospital.
Results. Laboratory criteria of anemia were registered in 5.9% of outpatients: in 1.5% of male individuals and 4.4% of female (p = 0.280), with the maximum incidence at the age of ≥ 75 years. Hemoglobin level in males was 116 ± 13.4 g/l, in females – 108 ± 11.5 g/l. Mild anemia was most often recorded in all age groups. Upon admission to the hospital, anemia was assessed as severe in 80.7% of patients, mild in 13.8%, and moderate in 5.5%. Among the different types of anemia, iron deficiency was predominant (72.2%), less common were vitamin B12 deficiency (12%) and anemia of chronic disease (13.1%). The cause of anemia was determined in 79.7% of cases, mainly it consisted of malignant neoplasms (41.4%).
Conclusion. In outpatient practice, the incidence of anemia in the adult population was 5.9%, in hospital practice – 39.7%. Outpatients were more likely to have mild anemia in all age groups, while hospitalized patients had severe anemia (80.7%). A high proportion of patients with malignant neoplasms was revealed, possibly due to low oncological alertness of the physician and the reluctance of patients to undergo necessary examinations.
Keywords
anemia
outpatients
hospitalized patients
severity of anemia
causes of anemia
References
1. Ховасова Н.О., Воробьева Н.М., Ткачева О.Н., Котовская Ю.В., Наумов А.В., Селезнева Е.В., Овчарова Л.Н. Распространенность анемии и ее ассоциации с другими гериатрическими синдромами у лиц старше 65 лет: данные российского эпидемиологического исследования ЭВКАЛИПТ. Терапевтический архив. 2022;94(1):24–31. (Khovasova NO, Vorobyeva NM, Tkacheva ON, Kotovskaya YuV, Naumov AV, Selezneva EV, Ovcharova LN. The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT. Terapevticheskiy arkhiv = Therapeutic Archive. 2022;94(1):24–31 (In Russ.)).
EDN: XUCHKT. https://doi.org/10.26442/00403660.2022.01.201316
2. Юдин Г.В., Рыбка М.М., Хинчагов Д.Я., Дибин Д.А., Гончаров А.А. Анемия как фактор риска дисфункции внутренних органов у больных, оперируемых по поводу приобретенных пороков сердца. Кардиология. 2021;61(4):39–45. (Yudin GV, Rybka MM, Khinchagov DYa, Dibin DA, Goncharov AA. Anemia as a risk factor for organ dysfunctions in patients operated on heart valves. Kardiologiya = Cardiology. 2021;61(4):39–45 (In Russ.)).
EDN: INETHR. https://doi.org/10.18087/cardio.2021.4.n1596
3. Stauder R, Valent P, Theurl I. Anemia at older age: Etiologies, clinical implications, and management. Blood. 2018;131(5):505–14.
PMID: 29141943. https://doi.org/10.1182/blood-2017-07-746446
4. GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: Findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023;10(9):e713–e734.
PMID: 37536353. PMCID: PMC10465717. https://doi.org/10.1016/S2352-3026(23)00160-6
5. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity.
URL: https://apps.who.int/iris/bitstream/handle/10665/85839/WHO_NMH_NHD_MNM_11.1_eng.pdf?sequence=22&isAllowed=y (date of access – 14.05.2025).
6. Котенко О.Н., Абольян Л.В., Кутейников В.Ю., Виноградов В.Е., Фомин В.В. Анемия и качество жизни пациентов с хронической болезнью почек на заместительной почечной терапии методом программного гемодиализа. Терапевтический архив. 2023;95(1):32–37. (Kotenko ON, Abolyan LV, Kuteinikov VYu, Vinogradov VE, Fomin VV. Anemia and quality of life of chronic kidney disease patients on renal replacement therapy by programmed hemodialysis. Terapevticheskiy arkhiv = Therapeutic Archive. 2023;95(1):32–37 (In Russ.)).
EDN: XYIVNT. https://doi.org/10.26442/00403660.2023.01.202050
7. Верткин А.Л., Ховасова Н.О., Ларюшкина Е.Д., Шамаева К.И. Анемия у амбулаторного больного. Эффективная фармакотерапия. 2014;(8):6–9. (Vyortkin AL, Khovasova NO, Laryushkina ED, Shamaeva KI. Anemia in ambulatory practice. Effektivnaya farmakoterapiya = Effective Pharmacotherapy. 2014;(8):6–9 (In Russ.)). EDN: SWNRYP.
8. Акимова А.В., Невская А.В., Милащенко А.И., Кондрашова Е.В. Особенности анемии хронических заболеваний в терапевтическом стационаре. Вестник уральской медицинской академической науки. 2018;15(1):5–11. (Akimovа AV, Nevskaya AV, Milashchenko AI, Kondrashova EV. Clinical features of anemia of chronic diseases in the therapeutic hospital. Vestnik uralskoj meditsinskoy akademicheskoy nauki = Journal of Ural Medical Academic Science. 2018;15(1):5–11 (In Russ.)).
EDN: YWMLJC. https://doi.org/10.22138/2500-0918-2018-15-1-5-11
9. Богданов А.Н., Щербак C.Г., Павлович Д. Анемии в пожилом и старческом возрасте. Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2018;10(2):19–26. (Bogdanov AN, Shcherbak SG, Pavlovich D. Anemias in elderly and old. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta imeni I.I. Mechnikova = Herald of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):19–26 (In Russ.)).
EDN: XUOITR. https://doi.org/10.17816/mechnikov201810219-26
10. Desai SP, Isa-Pratt S. Clinician's guide to laboratory medicine. A practical approach. 2nd edition. Hudson, Ohio: Lexi-Comp. 2000. ISBN: 9780916589936, 0916589935.
11. Madu AJ, Ughasoro MD. Anaemia of chronic disease: An in-depth review. Med Princ Pract. 2017;26(1):1–9.
PMID: 27756061. PMCID: PMC5588399. https://doi.org/10.1159/000452104
12. Миронова О.Ю., Панферов А.С. Анемия хронических заболеваний: современное состояние проблемы и перспективы. Терапевтический архив. 2022;94(12):1349–1354. (Mironova OYu, Panferov AS. Anemia of chronic diseases: Current state of the problem and perspectives. Terapevticheskiy arkhiv = Therapeutic Archive. 2022;94(12):1349–1354 (In Russ.)).
EDN: AQCAOE. https://doi.org/10.26442/00403660.2022.12.201984
13. Duck KA, Connor JR. Iron uptake and transport across physiological barriers. Biometals. 2016;29(4):573–91.
PMID: 27457588. PMCID: PMC4972853. https://doi.org/10.1007/s10534-016-9952-2
14. Wiciński M, Liczner G, Cadelski K, Kołnierzak T, Nowaczewska M, Malinowski B. Anemia of chronic diseases: Wider diagnostics – better treatment? Nutrients. 2020;12(6):1784.
PMID: 32560029. PMCID: PMC7353365. https://doi.org/10.3390/nu12061784
About the Authors
Vera N. Larina, MD, Dr. Sci. (Medicine), professor, head of the Department of outpatient therapy of the Institute of Clinical Medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Pirogov University). Address: 117513, Moscow, 1/6 Ostrovityanova St.E-mail: larinav@mail.ru
ORCID: https://orcid.org/0000-0001-7825-5597. Scopus ID: 36850407300. eLibrary SPIN: 3674-9620
Ekaterina V. Kudina, MD, PhD (Medicine), associate professor, associate professor of the Department of outpatient therapy of the Institute of Clinical Medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Pirogov University). Address: 117513, Moscow, 1/6 Ostrovityanova St.
E-mail: e-kudina@mail.ru
ORCID: https://orcid.org/0000-0002-9547-078X. eLibrary SPIN: 8163-2695
Elena N. Sheregova, MD, PhD (Medicine), associate professor of the Department of outpatient therapy of the Institute of Clinical Medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Pirogov University). Address: 117513, Moscow, 1/6 Ostrovityanova St.
E-mail: esheregova@list.ru
ORCID: https://orcid.org/0000-0001-9991-546X. eLibrary SPIN: 3750-0858
Kirill A. Zamyatin, MD, postgraduate student of the Department of outpatient therapy of the Institute of Clinical Medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Pirogov University). Address: 117513, Moscow, 1/6 Ostrovityanova St.
E-mail: kazamiatin@gmail.com
ORCID: https://orcid.org/0000-0001-6271-228X. eLibrary SPIN: 4331-7090
Anna E. Polivanova, MD, PhD (Medicine), therapist at D.D. Pletnev City Clinical Hospital of the Department of Healthcare of Moscow. Address: 105077, Moscow, 32 11th Parkovaya St.
E-mail: apolivanova@mail.ru
ORCID: https://orcid.org/0009-0005-7994-5609
Nadezhda A. Baykova, MD, head of the Department of therapy, therapist at D.D. Pletnev City Clinical Hospital of the Department of Healthcare of Moscow. Address: 105077, Moscow, 32 11th Parkovaya St.
E-mail: nadik_86@bk.ru
ORCID: https://orcid.org/0000-0003-1745-0000
Ilya V. Vavilov, resident of the Department of hospital therapy of the Institute of Maternity and Childhood, N.I. Pirogov Russian National Research Medical university of the Ministry of Healthcare of Russia (Pirogov University). Address: 117513, Moscow, 1/6 Ostrovityanova St.
E-mail: vavilovilya999@gmail.com
ORCID: https://orcid.org/0009-0003-9831-201X
Irina A. Baranova, MD, Dr. Sci. (Medicine), professor, professor of the Department of hospital therapy of the Institute of maternity and childhood, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Pirogov University). Address: 117513, Moscow, 1/6 Ostrovityanova St.
E-mail: iribaranova@yandex.ru
ORCID: https://orcid.org/0000-0002-2469-7346. Scopus ID: 7006313142. eLibrary SPIN: 6855-0720
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