Anemia is quite frequently diagnosed in older individuals and is a key indicator of various reactive and clonal conditions. Many underlying diseases, like myelodysplastic syndrome (MDS), develop preferentially in elderly individuals. The prevalence of anemia at older age is increasing, and this is mainly attributable to more frequently applied diagnostics and demographic changes in our societies. The etiology of anemia at older age is complex and ranges from bone marrow failure syndromes to chronic kidney disease, and from nutritional deficiencies to inflammatory processes including inflammaging in immunosenescence. In a smaller number of cases, no clear-cut etiology is identified. These patients are referred to as unexplained anemia or idiopathic cytopenia of unknown significance. In others, somatic mutations in leukocytes are found, but diagnostic criteria for MDS or other hematologic diseases are not fulfilled, a condition termed clonal cytopenia of undetermined significance. Management of anemias at older age depends on (1) the severity of the anemia, (2) underlying condition(s), and (3) patient-related factors, including comorbidities. Even a mild anemia may substantially affect physical and cognitive capacities and quality of life. An underestimated aspect is that because of age-related changes, organ function such as erythropoietin production in the kidney may become suboptimal. Management and treatment of anemia in older patients often require a multidisciplinary approach and detailed investigations of organ function. In this article, we review current concepts around anemias at older age, with special emphasis on etiologies, clinical implications, and innovative concepts in the management of these patients.

中文翻译：

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老年贫血：病因、临床意义和管理

贫血在老年人中经常被诊断出来，并且是各种反应性和克隆性疾病的关键指标。许多基础疾病，如骨髓增生异常综合征 (MDS)，优先发生在老年人身上。老年贫血的患病率正在增加，这主要是由于我们社会中更频繁地应用诊断和人口结构变化。老年贫血的病因很复杂，范围从骨髓衰竭综合征到慢性肾病，从营养缺乏到炎症过程，包括免疫衰老中的炎症。在少数情况下，没有确定明确的病因。这些患者被称为不明原因的贫血或意义不明的特发性血细胞减少症。在其他情况下，发现白细胞中的体细胞突变，但未满足 MDS 或其他血液系统疾病的诊断标准，这种情况称为意义不明的克隆性血细胞减少症。老年贫血的管理取决于 (1) 贫血的严重程度，(2) 基础疾病，以及 (3) 与患者相关的因素，包括合并症。即使是轻度贫血也可能严重影响身体和认知能力以及生活质量。一个被低估的方面是，由于年龄相关的变化，肾脏中的促红细胞生成素等器官功能可能变得不理想。老年患者贫血的管理和治疗通常需要多学科方法和器官功能的详细调查。在本文中，我们回顾了当前有关老年贫血的概念，特别强调了病因、临床意义、