It has been reported that anemia occurs in close to 35% of the elderly population between the ages of 60-79, and up to 45% by the age of 80 or older. The so-called anemia is actually mainly caused by the decrease of red blood cells and hemoglobin (Hb) content in the blood. That is, in China, adult men with Hb <120g/liter and women with Hb <110g/liter are anemic; and the World Health Organization defines anemia for people over 65 years old as <130g/liter for men and <120g/liter for women. I. Iron deficiency anemia in the elderly 1. Definition and causes Iron is one of the important raw materials for Hb synthesis, when the body lacks iron, it will affect the synthesis of Hb and lead to anemia. The amount of iron in the body of normal adults (elderly people refer to adults) is 3-5 grams. The amount of iron in the body of a normal adult (adult reference) is 3-5 grams. The reason why the elderly are anemic is firstly related to the decline of hematopoietic function, which is caused by age and is a natural phenomenon; in addition, the most common nutritional anemia in the elderly, that is, iron deficiency anemia, is mainly due to the poor teeth and chewing ability of the elderly, coupled with poor digestion and absorption, and many elderly people have various chronic diseases, which restrict many foods, especially meat, which is rich in iron and vitamin B12. which happens to be the main raw material for hematopoiesis, causing insufficient intake; if elderly people have frequent blood loss, such as gastrointestinal bleeding, bleeding hemorrhoids, or even serious diseases like cancer, they will often lose red blood cells, resulting in insufficient endogenous iron. Therefore, it is important to find out the reason behind the anemia to see if it is a common nutritional anemia or a hidden more serious malignant disease. 2. Prevention and control measures Iron mainly comes from meat, liver, fish in food and iron pans in tableware. Iron in plant food is more difficult to absorb than iron in animal food, meat and acidic drugs such as vitamin C can promote the absorption of iron, on the contrary salts that can combine with iron, such as vegetable salts and phosphates, can reduce the absorption of iron. In order to promote the absorption of iron, attention should be paid to eating some acidic foods, such as tomatoes, sour dates, sour cucumbers, acidic fruits, etc., less strong tea, coffee, eggs, milk and antacid drugs can interfere with the absorption and utilization of iron. Actively identify the cause of the disease, while treating the cause, appropriate iron supplements. Ferrous sulfate, ferrous fumarate and ferrous gluconate are often used. Iron supplements can be taken during or after meals to reduce their side effects, while vitamin C is taken to promote iron absorption. Only when serious for intestinal reactions and can not tolerate oral iron, or chronic abdominal pain and diarrhea, gastrointestinal surgery affect the absorption of iron, only consider the injection of iron dextrose and other preparations for treatment. In severe cases, infusion of red blood cell suspension. The above dosage should be applied under the guidance of professional doctors. 3.Living Guide Anemia in the elderly often has atypical symptoms and is easily overlooked by family members and doctors. Generally, symptoms such as weakness, panic, shortness of breath, precordial pain, dizziness and blurred eyes should be highly valued, which will further develop into pallor, stomatitis, tongue inflammation, atrophy of tongue papillae, difficulty in swallowing, dry skin keratinization, hair easily breaking and falling off, nails not shiny and neat, flat nail or anti nail formation, etc. If the above symptoms and diseases appear, you can go to the hospital in time to have a simple blood test, and if it is anemia, you need to follow the medical advice for relevant treatment. It is known that dietary supplements can play a role in both replenishing nutrition and improving anemia. You should pay attention to a diet rich in vitamin C and iron-rich foods. It should be reminded that the iron content in supplements such as gum is not enough, and medication is also needed to supplement and treat primary diseases such as chronic gastrointestinal bleeding, bronchial dilation, cancer, inflammation of the urinary tract, vaginal inflammation and bleeding. Pay attention to bleeding induced by drugs such as aspirin, and discontinue such drugs in time for timely detection. 2. Megaloblastic anemia in the elderly 1. Definition and causes Megaloblastic anemia is a disease caused by folic acid and/or vitamin B12 deficiency or other causes of impaired DNA synthesis and slowed DNA replication. Folic acid is widely found in various foods, with the highest content in green vegetables, fruits and vegetables, liver and dairy products. Nutritional megaloblastic anemia is one of the common causes of anemia in the elderly, with folic acid deficiency being the most common. Folic acid deficiency can be seen in elderly people with a lack of intake due to dental diseases lasting for 3-4 months; various jejunal disorders, certain drugs such as anti-epileptic drugs, salbutamol and ethanol can inhibit the absorption of folic acid; folic acid antagonistic drugs such as methotrexate, aminopterin and ethambutol, as well as congenital deficiency of certain enzymes can affect the metabolism and utilization of folic acid; hyperthyroidism, infections, tumors and pregnant and lactating women, the need for folic acid can be reduced. Hyperthyroidism, infections, tumors, and pregnant and lactating women may induce anemia when folic acid needs are increased without careful supplementation. It takes 10-15 years for a complete vegetarian to show signs of vitamin B12 deficiency. 2. Prevention and control measures Elderly people should pay attention to nutrient supplementation, correct partial food and bad cooking habits, and eat more fresh vegetables and animal protein. Some elderly people who suffer from coronary heart disease, diabetes and hypertension and blindly control their diet can also cause megaloblastic anemia. Therefore, a scientific diet should be prepared to prevent the occurrence. Treatment with folic acid and vitamin B12 supplementation should be accompanied by active treatment of the primary disease. Supplementation for folic acid deficiency: oral folic acid, 5 mg each time, 3 times a day; for intestinal malabsorption, intramuscular injection of calcium formyl tetrahydrofolate 3 mg/day can also be given until the blood picture returns to normal. If there is also iron deficiency, folic acid should be supplemented for several days, and iron should be given again when the gastrointestinal symptoms disappear. If there is also vitamin B12 deficiency, vitamin B12 must be injected at the same time, otherwise it will lead to neurological damage due to vitamin B12 deficiency. Pernicious anemia, gastrectomized patients and congenital endogenous factor deficiency require lifelong vitamin B12 injections for treatment. Folic acid deficiency is often accompanied by multivitamin deficiency, and needs to be supplemented with vitamin C, vitamin B1 and vitamin B6. 3.Living Guide Generally speaking, elderly people with obvious loss of appetite, diarrhea, abdominal distension and tongue inflammation, and a red tongue with pain, atrophy of the tongue papillae, smooth tongue (called "beef tongue"), and accompanied by drowsiness or mental The first thing to consider is folic acid deficiency. You should actively go to the hospital for examination and treatment. If there is weakness, numbness of hands and feet, sensory impairment, difficulty walking and other symptoms of peripheral neuritis, as well as subacute or chronic joint degeneration of the posterior spinal cord, vitamin B12 deficiency is the most common cause, and if left untreated, it will most likely develop into pernicious anemia, resulting in a long and ineffective treatment process. Long-term heavy alcohol consumption can cause megaloblastic anemia, because alcohol can hinder the absorption and utilization of folic acid and vitamin B12, so elderly people should avoid smoking and alcohol in time; elderly people should pay attention to screening when using medications, and ethamethazine, phenytoin sodium, barbiturate sodium, isoniazid, ethanol, botrytisone, and aminopterin also inhibit the absorption and utilization of folic acid and vitamin B12. Aplastic anemia in the elderly 1. Definition and causes Aplastic anemia (referred to as "reblast") is a group of chemical, physical, biological factors or unexplained damage to bone marrow stem cells and/or hematopoietic microenvironment. Primary reoccurrence is more common in adolescents and is less common in the elderly. Secondary reoccurrence is caused by chemicals (e.g., stupid), ionizing radiation, infections (some viruses, such as hepatitis virus and EBV), and drugs (especially antibacterial drugs, antineoplastic drugs, antirheumatic drugs, adamantine agents, and anticonvulsant agents). The incidence has increased in the elderly population in recent years, and the incidence gradually increases with age in women, which may be related to the decrease in estrogen levels in the body. 2, prevention and control measures Actively search for the causative factors and break contact with them, avoid all substances that cause myelosuppression; before treatment takes effect, Hb can be maintained at a certain level through blood transfusion; prevent bleeding and infection; stimulate bone marrow regeneration by various methods. Commonly used drugs include: acetone, testosterone undecanoate, stanozolol, dehydrotestosterone, and in the acute type, anti-thymocyte globulin, anti-lymphocyte globulin and adrenocorticotropic hormone are available. The use of androgens in elderly male patients should be noted for possible aggravation of prostatic hypertrophy. In recent years, cyclosporine has been widely used in acute and chronic remittance. It can also be combined with herbal medicines that benefit Qi and nourish blood, strengthen the spleen and warm the kidney. Anemia can be relieved in some elderly patients after splenectomy, but they are not suitable for bone marrow transplantation due to age restriction. 3. Guidelines for living Elderly people should be sent to hospital for consultation and treatment as soon as the first symptoms such as anemia, bleeding and infection appear. Most elderly people have a slow onset, with anemia as the first symptom, light bleeding and easily controlled infections. When coexisting with other diseases of the elderly, the symptoms are not typical and easily misdiagnosed. The elderly have a history of exposure to pathogenic factors, such as drugs, so they should pay attention to prevention and go to the hospital for blood tests. Tumor-associated anemia in the elderly 1. Definition and causes Tumor-associated anemia in the elderly is called tumor-associated anemia (CRA for short). Usually, tumors of digestive tract and hematopoietic cell tumors are the most common. 2. Prevention and control measures Active control of the primary disease and blood transfusion therapy are the main measures to treat CRA. For example, the anemia caused by bleeding and tumor invasion of bone marrow in gastrointestinal tumor, cervical cancer, endometrial cancer and urological tumor can not be corrected if the primary disease is not effectively controlled. Perioperative blood transfusion and post-chemotherapy blood transfusion are also the main means to correct anemia. However, its efficacy is maintained for a short time and its adverse effects are large, mostly fever, rash, hepatitis HIV transmission, production of specific antibodies, etc. It also cannot completely improve the prognosis, and blood transfusion is only considered when Hb<60g/L. Erythropoietin (EPO) is an autocrine hormone, mainly produced in the kidney, which promotes the maturation of erythrocyte secretion through the binding of EPO receptors on the membrane surface of bone marrow precursor erythrocytes. EPO is effective in the treatment of CRA, with an efficiency of 40-79%, and its application can reduce the need for blood transfusion by 50% and improve the quality of survival, but the risk of thrombophilia is also increased and can be used as appropriate. In patients with the presence of bleeding, appropriate hemostatic drugs are given. In addition, megaloblastic anemia and iron deficiency anemia are more frequent in elderly CRA patients, so attention should be paid to iron supplementation and folic acid and vitamin B12. 3. Life guidelines With the progress of science, the survival of elderly oncology patients is significantly longer, and the impact of CRA on the quality of life of the elderly is increasing. Blood transfusion and the use of EPO are currently the most common methods of treatment, but aggressive anti-tumor therapy is fundamental. Although there are still many problems in the treatment of CRA, the pathogenesis of CRA and its impact on tumor treatment and prognosis are gradually becoming clearer, and physicians are paying more attention to it, and CRA will definitely receive more and more standardized and effective treatment.