Background and objectives Nutritional deficiencies, renal impairment and chronic inflammation are commonly mentioned determinants of anaemia. The aim of this study was to investigate the effects of... Show moreBackground and objectives Nutritional deficiencies, renal impairment and chronic inflammation are commonly mentioned determinants of anaemia. The aim of this study was to investigate the effects of these determinants, singly and in combination, on anaemia in the very old. Method The TULIPS Consortium consists of four population-based studies in oldest-old individuals: Leiden 85-plus Study, LiLACS NZ, Newcastle 85+ study, and TOOTH. Five selected determinants (iron, vitamin B12, and folate deficiency; low estimated glomerular filtration rate (eGFR); and high C-reactive protein (CRP)) were summed. This sum score was used to investigate the association with the presence and onset of anaemia (WHO definition). The individual study results were pooled using random-effects models. Results In the 2216 participants (59% female, 30% anaemia) at baseline, iron deficiency, low eGFR and high CRP were individually associated with the presence of anaemia. Low eGFR and high CRP were individually associated with the onset of anaemia. In the cross-sectional analyses, an increase per additional determinant (adjusted OR 2.10 (95% CI 1.85-2.38)) and a combination of >= 2 determinants (OR 3.44 (95% CI 2.70-4.38)) were associated with the presence of anaemia. In the prospective analyses, an increase per additional determinant (adjusted HR 1.46 (95% CI 1.24-1.71)) and the presence of >= 2 determinants (HR 1.95 (95% CI 1.40-2.71)) were associated with the onset of anaemia. Conclusion Very old adults with a combination of determinants of anaemia have a higher risk of having, and of developing, anaemia. Further research is recommended to explore causality and clinical relevance. Show less
Silva, S.L. da; Vellas, B.; Elemans, S.; Luchsinger, J.; Kamphuis, P.; Yaffe, K.; ... ; Stijnen, T. 2014
The aim of this thesis was to study the impact and etiology of anemia in the oldest old in the general population, in order to support the development of evidence-based diagnostic and treatment... Show moreThe aim of this thesis was to study the impact and etiology of anemia in the oldest old in the general population, in order to support the development of evidence-based diagnostic and treatment recommendations for anemia in the oldest old. All studies presented in this thesis were embedded in the Leiden 85-plus Study and the Newcastle 85-plus Study. First, the impact of anemia was investigated. Anemia in old age appeared to be associated with an increased risk of death, independent of comorbidity, but the associated functional decline appeared to be attributed mainly to comorbidity. In various chapters, the etiology of anemia in old age was studied. An important finding was that, while folate deficiency at age 85 years was associated with the development of anemia during follow-up, vitamin B12 deficiency was not. In addition, low ferritin was associated with lower hemoglobin levels, but this association was more pronounced in participants with inflammation than in participants without inflammation. In the general discussion, a description of the possible clinical implications of this thesis and recommendations for further studies are provided. Show less
Homocysteine is a risk factor for venous thrombosis. Elevated concentrations can be treated with folic acid, vitamin B6 and vitamin B12. The main study (chapter 9) in this thesis is a randomized... Show moreHomocysteine is a risk factor for venous thrombosis. Elevated concentrations can be treated with folic acid, vitamin B6 and vitamin B12. The main study (chapter 9) in this thesis is a randomized placebo-controlled trial in which patients with a first event of deep-vein thrombosis or pulmonary embolism are treated with above mentioned vitamins or a placebo. There was no effect of vitamin treatment on recurrent thrombosis. A case-control study is described whichs shows that elevated homocysteine concentrations are a risk factor for venous thrombosis and pulmonary embolism in elderly patients (chapter 7). Two studies deal with acidic citrate as an anticoagulant in blood collection tubes. We show that acidic citrate stabilizes homocysteine concentrations at room temperature (chapter 3) and that the homocysteine concentrations measured in blood collection tubes with acidic citrate as anticoagulant correlate well with the concentrations measured in blood tubes with EDTA as anticoagulant (chapter 4). One study compared patients on and off anticoagulant therapy. There was no influence of coumarin derivatives on plasma homocysteine concentrations (chapter 5). The endogeous thrombin potential is not different in patients with high homocysteine concentrations in comparison to patients with low homocysteine concentrations (chapter 6). Show less
