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Prevention, Early Detection & Management of Anemia in the Elderly

Jan 10 | 1:30 PM

When compared to other other emerging countries, India is estimated to have a higher prevalence of anaemia. Anemia affects 39.86 percent of Indians, according to the Ministry of Health and Family Welfare. The primary care physician, who serves as the backbone of the health-care system and a patient's initial point of contact, is critical in the detection and management of anaemia. As a serious public health issue, efforts should be made to reduce anemia's prevalence and increase an individual's, community's, and country's health. Join us live, in conversation with Dr. G.S. Grewal to learn about the newest developments in anaemia management and government programmes aimed at addressing this public health concern.

[Music] hi good evening everyone i am dr blossom and i welcome you all on behalf of the netflix uh this evening we are going to uh look over one of the often overlooked conditions in elderly uh that is anemia and for that we have with us dr g as s gravel he is a senior consultant at fortis escort oakland delhi he is also the president of indian medical association of delhi zone with a career that started in 1978 he is one of the leading physicians of the country and is a pioneer in the field of elder care sir is very passionate about geriatric health and is a chairman of the non-profit organization called wellness health and you he has given many talks on the betterment of the health care for the elderly he is credited with launching the who's age friendly community initiative in india i welcome you sir thank you thank you dr blossom kind of you thank you over to you sir good evening to all of you and thank you dr blossom for uh production i don't know whether i deserve that or not but coming from nothing person it's welcome it's my privilege to bring you greetings from wellness health in you and before i start my presentation i like to first give you a salute in respect as you have been serving the society with dedication and an unparalleled passion you have made for yourself a reputation which is holding good after so many years that is instrumental in ensuring your economic and social stability even today so you worked your way up and that is what is supporting you and i salute you for that well the topic of the day today is anemia and the elderly both seem to be a very common occurrence anemia and the elders you have plenty of them around today my presentation will cover about six parts and your suggestions welcome are welcome at the end of the presentation well ladies and gentlemen there is government of india's star program i don't know how many of you are aware of it because i will have been speaking to a number of doctors of the past few days and i find very little people know about the anemia bharat campaign or the government of india and they have identified the causes of high burden of anemia in india and these causes come from different sources it could be low iron stored dietary iron loss or material anemia and these four make up the large bulk of the burden of anemia in india so if we are able to manage these four we are able to manage the burden to begin as an academic slide we do have different types of anemia anemia is differentiated into iron deficiency vitamin anemia of inflammation aplastic anemia anemia associated with bone marrow disease and hemolytic anemias well this is the general class of anemias we generally differentiate them because each one of them requires a different way of investigation and a different treatment causes clinically specifically for the elders it is said that 80 percent of the time we are able to identify a cause in the elderly and in elderly the common causes are chronic diseases kidney disease bronchitis even copd is very common in the elderly and anemia associated with copd iron deficiency vitamin b12 folic acid gastrointestinal bleeding upper gut and lower gut is quite common in the elderly and goes unnoticed for a period where hemoglobins as low as four and five are identified myelodysplastic syndrome a new coming cause for elderly anemia till some time back it was not considered to be the milo this plastic syndrome was not considered akin to malignancy but of late it is considered a precursor of malignancy and has to be handled with medication and prevention of further deterioration it is said that you can slow down the process but you may not be able to cure it this is a chart showing causes of anemia based on two different groups the one basic group is so one is because of increased blood cell destruction one on the left side and that is based on the destruction happens in nutritional anemias in bone marrow disorders and in infectious diseases so in all these features you get red cell destruction and in this right side chart is decreased let's say red cells production which is because of acute chronic blood loss acute or chronic and the genetic disorder group in which you have the hemolytic anemia the g6pd thalassemia and sickle cell these do not form importance in the elderly but for academic reasons i mentioned them here what more is in elderly is seen more is red cell destruction the common presenting symptoms of anemia well we have this list which can exist together individually or in combination so you can have somebody presenting with just weakness and chest pain you can have somebody presenting with irregularity in heartbeat and fatigue you can have irregularity of the heartbeats and you can have paler skin and paler conjunctive so these combinations these are not in order of presentation or in order of incidents they have just been listed elderly can present with a singular complaint or a combination complete so you have these all have to be kept in mind before we just put off somebody and say you do not have any problem with anemia these symptoms of anemia arise from different organs of the body because anemia affects the entire body obviously when blood is circulating in the entire body the various organs are affected by anemia so you can have low hemoglobin affecting the respiratory system and therefore the person might come with shortness of breath if he has uh if the elder if the individual has a problem with the gastrointestinal systems obviously he might come with a black stool and that's that may be the only complaint there are instances when they come with just single one complaint and say i just had black stools for the last four days and you get their hemoglobin tested and it turns out to be hardly fight so this is different organs of the body get affected by anemia and they can different organs presentations will obviously be different so remember this because it is going to affect the entire body a singular complaint from a particular organ has to be looked into widely in the context of anemia anemia means multi-organs problems may not be disease but can have different problems coming to the anemia prevalence in the elderly by who standards anything less than 12 in females and anything less than 13 in males is considered as anemia and the prevalence of anemia and the elderly has been found in the range of 8 to 44 look at this wide range and the highest prevalence is at the age of 75 in the males 8 to 44 varying with age and sexes it differs at the age of 65 and male female similarly at the next decade of 75 and beyond so these are the reasons for difference of 8 to 49 but it is very obvious that as people grow the incidence of anemia is higher and more in males than in females so as much as the males may call themselves the class they suffer more from anemia clinical evaluation of anemia in the elderly starts with assessment for blood loss now the assessment for blood loss which may be acute or chronic start from estimation of things like pcb the hemoglobin the red blood cell morphology all these will be signs to find out for blood loss which is a part of evaluation for anemia nutritional laboratory investigation for b12 and folic acid estimation malignancy of the large gut so you have to evaluate the large cut malignancy when you're investigating for anemia and chronic infections you might have to do kidney function test you do a urine for albumen if you find that the person is passing a lot of albumen and has a kidney disease the management of anemia changes totally now in laboratory evaluation one rule has to be understood that in patients with evidence of an underlying disease evaluation of that disease will precede any evaluation of anemia so just going into hemoglobin the evaluation of anemia without evaluating the underlying disease you are going to be in trouble because unless and until the underlying disease is managed the anemia cannot be corrected and in patients without evidence of underlying disease the initial laboratory evaluation should include a complete blood count red blood cell indices a reticulocyte count and the peripheral blood smear a peripheral blood smear is mandatory many times it is not asked for by the physicians treating physicians and peripheral blood smear gives a lot of information as far as anemia is concerned the full blood ground usually provides the first evidence of anemia that is low hemoglobin the peripheral blood film may reveal red cell abnormalities characteristic of a certain particular disorders the reticulocyte count which is called the retics is a very important marker in anemia a low count indicates bone marrow hypoplesia and a high count indicates that the bone marrow is still active in responding so if you have a low retic count your investigating line suddenly turns towards a bone marrow hypoplasia so the other causes take a back seat and prone hypoplesia becomes a prominent one and you will probably go in for a bone marrow testing a bone marrow aspirate which is done whenever there is a hypoplesia should be taken if a primary marrow disorder is suspected myelodysplasia or leukemia this is an important addition in the arbiterium of diagnosing anemia in elders remember myelodysplasias are now being diagnosed because initially those anemias were put into the category of unknown category but now when bone marrows are being done in the elderly we are seeing premature cells and different cell morphology and the diagnosis of a milo dysplasia is made and preventive steps are taken for the progression of the disease similarly pneumatic essays for serum ferritin b12 folate should be evaluated in all cases iron deficiency may mask this is important that iron deficiency may mask the megaloplastic changes of b12 in a bone marrow smear well the commonest cause of anemia in india is iron deficiency anemia idea which is called if the commonest calls irrespective of age higher in the elderly iron is an essential constituent of the hemoglobin and hence rbc's require large amounts of iron symptoms due to deficit of hemoglobin the degree of anemia depends upon the iron deficit so both are absolutely connected with each other every cell in the body contains iron and loss of any cell from the body skin or gut results in eye loss that is called obligatory loss so if you have a disease of the skin you have an inflammatory area where you are losing tissue so tissue has cells and every cell has hemoglobin so therefore because every cell has hemoglobin uh has iron in it so whenever there is cellular loss you will have iron loss and cause anemia which is called obligatory iron loss then there is the occult loss or cut loss like we say in which you cannot see so the the classical example in elderly is gut bleeding may be because of a disease or because of medication in the elderly you have a lot of cases where because of polypharmacy they do have blood loss which is not seen any other way except sometimes an occult blood test in a stool can give rise to a suspicion of anemia because of blood loss so therefore extra requirements to meet specific demands include growth pregnancy and blood donation those are the times where special attention has to be paid to the iron loss laboratory investigation specifically in iron deficiency anemia consists of a blood count serum ferritin serum iron and total iron binding capacity serum transferrin and bone marrow so these are the previous slides i showed you were investigation for anemia as such in whenever iron deficiency is suspected these are the investigations which are lined up for especially for iron deficiency laboratory findings in iron deficiency i put them in a table ferritin is below 40 serum iron is below 50. anything below 50 is considered as low serum iron and transfer and saturation so these are the lab findings in case of iron deficiency anemia and once you have any one of these readings on them any one of them with a low hemoglobin your diagnosis of the particular iron deficiency anemia are made so these are important algorithms treatment with in certain that is important and therefore there are algorithms for management of anemia the algorithm then the next finding then the next finding and then there is treatment so just giving an iron tablet is not going to manage your disease unless you follow a certain algorithm and these algorithms have been made available it is the basis unless and until you follow this so if there is an mcb which is less than 80 you are sure that there is a die sorry there is a diagnosis of microcytic anemia now there immediately the iron deficiency comes into mind similarly if the mcb is more than 80 you can have a normal acidic anemia and then the system and diseases become more prominent so you have correct means crp and folates which are more important so it is very systematic and often we have seen that if this way of arriving at the diagnosis is not followed patients come that they have been having an iron tablet for the last three months but hemoglobin is not improving from five to six that is because that individual's case has not been understood so it is a systematic manner and it makes sense for every individual to follow this because only then you can arrive at the diagnosis and give proper treatment similarly examination of the full blood picture and peripheral blood smear again the moment you have the reports in front of you keep this chart with you you're allowed to use a chart nobody is going to fail you it's a kunji i remember kunji in school we always we've all passed our exam using helpful books in our time we used to call them kunjis so we've all used them so use this chart after you have received the investigations this is important that you use the charts [Music] now treatment of anemia has three basic fundamentals you treat the comorbidities no up if this person needs iv replacement i got so therefore which medicine to be given at which time will depend upon the individual and therefore not to create confusion i'm limiting myself that when treating anemia if somebody has a copd and you do not provide treatment to the copd let me tell you this anemia will not improve if somebody comes to you with a complaint of breathlessness and you do find that he has an injection fraction of around 40 percent and he has a low serum iron you correct the serum iron the breathlessness will go but till such time you have to help him heart healthy heart so treatment of comorbidities is so important in the treatment of anemia that for getting the result i'm not saying better result getting the result you need to treat the co morbidities there could be an existence of tiber closes so if you are not going to treat the tuberculosis as much as vitamins and injections that you can give the anemia is not going to improve so treatment of the complications treatment of comorbidities and from this option list you will have to decide about the individual patient so every patient needs to have a different from from this list you can decide a combination you can give a b12 injection you can give an oral iron you can give injectable iron and b12 orally all this is appropriate according to what you find in the patient so ladies and gentlemen so much i've covered for hemoglobin the anemia the causes of anemia and the possible treatments possible combinations i will now come to the issue when we started the topic i said treatment of anemia and elderly well you may ask me what is the big deal what is the big deal with anemia with elders i mean why is anemia being discussed today with reference to elders especially and not to pregnancy not to children there is a reason and that reason is let me share with you that elders have multiple reasons to have anemia as a major issue so join me in understanding a little bit about the situation analysis of elders today obviously you will agree with me that any disease today we are talking about kovid every day somebody is asking your numbers numbers numbers so when i say that there is a problem a serious problem of anemia and elders that is because of what i'm going to show you life expectancy in 1947 was 32. today it is 69 for females and 66 for males longevity is a marvel of science but it has also brought a new set of problems for those living longer and some of the problems that longevity has brought is diseases which were hitherto not seen are being seen and two major issues that elders face in our country is ageism and abuse and it is because of longevity and i would like to share with you that in india a peculiar phenomenon is happening and that is feminization in aging after the age of 75 the average age of an individual for females is around 12 to 14 years but for males is around 10 to 12 years so as people are going beyond 75 and 80 the proportion of females is going higher so between 70 and 80 the males are in higher proportion and their anemia is high and beyond 80 it is the female population which is more who are liable to be widowed and their anemia becomes a serious problem because of social situations also so you understand the elderly are the vulnerable group today the average population of elderly is growing look at this this is in fact the projections are that the population is going to object 70 of the elders are having at least one commodity obviously [Music] the elders have co-morbidities who says people beyond 65 more than seven percent is called an aging country india ladies and gentlemen today is around nine percent and is expected to be 13 so we are already a great nation before we become a rich nation now with that proportion of numbers i you as physicians u.s physicians who receive patients of any speciality because elders have problems from all specialties they have eyes they have ears problem their throat their skin they have heart they have knees so they'll be visiting ortho petitions they'll be using gynecologists they'll be visiting visiting dermatologists they'll be visiting respiratory doctors so they are going to every speciality and they have one thing in common and that is anemia so whichever speciality they go to anemia is going to be presenting to all special and therefore effects also in diagnosis of anemia and elderly frequently elderly signs of a disorder if an elderly person has hypertension and is doing very well his bp readings are 150 by 80 on his medication and he gets anemia a hemoglobin of less than eight even less than eight what happens the blood volume increases so when the blood volume increases as compensation this elderly person who is controlled with blood pressure but with heightened blood volume presents with breathlessness and if you do not suspect anemia in an elderly who presents with breathlessness and focus only on the heart he is going to get worse with all the medication that is given for breathlessness diuretics anything they give it makes the patient worse some elderly persons who have a my cognitive behavior memory loss when their hemoglobin goes below seven and they have lack of oxygen which is going to the brain they will present with a confused state and what is the diagnosis in the emergency alzheimer's confusion he's got a mental illness and nobody checked his hemoglobin and the moment you correct the hemoglobin you see a sea change in these elders absolutely changes so therefore my appeal to all of you unless clinicians consider anemia as a possibility in the elderly it is going to be easily overlooked when they are these are the above mentioned are the present incompletes that's my word of caution so therefore the challenge is in the elderly despite the high prevalence in the elderly several features of anemia are easily overlooked very important is the onset of symptoms and signs is usually insidious very slow so what elders do because it is very slow available to it and he doesn't think i'm unwell body adjusts accordingly and that is the reason why elderly anemia is diagnosed quite late at times very importantly the typical symptoms of anemia such as fatigue weakness and dyspnea are not specific [Music] foreign foreign i'm very specific when i i get very irritated when i hear this nothing in the body happens because of age except aging no disease comes because of aging so remember because they attributed to age and what do we do when we see a suspected patient with anemia first thing we do is we look into the the the skin the conjunctiva fail pallor can be helpful diagnostic but pallor can is very difficult to find the elderly so many of them have a cataract surgery then so it can be missed and therefore that is the challenge in the elderly to treat and diagnose besides from conjunctival value few other signs are attributes specifically to anemia now here comes there is an important aspect to understand that in the elderly these few symptoms which are specific to the aging is fatigue in the elderly which can be considered otherwise in the younger age group is considered to be a sign of anemia in the elderly so in the elderly the signs are to be taken up which are not considered in the younger age group therefore despite well developed diagnostic techniques and a choice of therapeutic options suiting the requirements of the anemia yet anemia remains and under diagnosed and undertreated in the elders and is a major cause of morbidity and mortality in them so ladies and gentlemen the anemia and elders is [Music] a big challenge easily treatable but easily missed and therefore i very emphatically say that anemia should not be accepted as an inevitable consequence of aging it should not and every physician of any speciality should be very careful that if any of the elders come with complaints of fatigue breathlessness or anyone the first diagnosis should be considered as anemia rather than anything else i would now like to spend a few slides on what are the government programs available for male 1 anemia because the very few people know about the anemia book bharat it's a phenomenal program the government launched it two years ago it has made a program called anemia mukbara six by six by six there are six beneficiaries identified there are six interventions identified there are six institutional mechanisms that we have to be put into place this is important to understand because government has made this project which is known to very few people the six beneficiary groups that they have made is children these are the the left are the six beneficiary groups the six interventions prophylactic those the it's a little shady because i've taken it from the government side and then on the right are the six institutional mechanisms go into them please study them i will tell you what is important about them every physician irrespective of what specialty he belongs to it could be an orthopedic surgeon a gynecologist an ophthalmologist can easily do a hemoglobin estimation of every elder who comes to their clinic and can manage the anemia in their own clinics and if doing so they will be participating in the national program my the government of india very enthusiastically has put these targets for 22 i have put in an rti to find out how many of these targets have been met if time permitting may be in the next three weeks i expect an answer i put an api to the government of india asking them of how many of these targets have been achieved or how close have they come to these targets it's important for physicians in the private sector to participate in the government programs to do their contribution towards national health building not just because they are in the private sector we will not do anything so therefore i thought is very important that this is an important information for every physician of every specialty so you may belong to any specialty if any elder person beyond 65 years comes to you do ask for a hemoglobin and serum iron estimation with the high incidence of anemia and elders you will pick up at least three out of ten who are anemic you have done your job it's important as physicians to look after health in totality not just by your own specialty so my mission ladies and gentlemen is to have an age-friendly india and india which is provides dignity and quality of life to all its elders because some years ago this was never possible today elders want to live a life of dignity and quality and have fun at the same time let's make sure that by at least making their hemoglobins perfect so that they are not tired thank you very much for your kind attention thank you so much sir for the informative session thank you so much for watching it was really lovely yeah so people want to know about thalassemia minor in elderly well thalassemia minor in elderly has never been an issue because that can if the hemoglobin is low because thalassemia is not a hemolytic cause it is just because the there is a morphological problem with the rpc so even if you find a minor thalassemia minor as an investigating during investigation you there is now by electrophoresis you can find out what is the portion of hemoglobin which is the fetal hemoglobin so if somebody has a hemoglobin of 12 and 40 is of that is fetal hemoglobin then that if the serum iron is normal b12 is normal all other features are normal then that doesn't need to be treated okay and so what is the best way to treat anemia in rural areas where there are no labs available see well there are certain classical bedside investigations which can in a rural setup the peripheral smear is always available today you do not have any rural area that does not have a lab it you may not have electrophoresis but investigation wise to find out a peripheral smear is possible a simple hemoglobin is possible by the two you can find out whether there is a morphological defect in the rbc or there is any hemorrhagic effect on the rbc which can be found out by a simple peripheral smear and empirically empirically a stool pla called blood can be done you can find out for and then existing co-morbidity comorbidities can be enlisted by taking this chart you can make a special algorithm chart and an approach in the rural area can be done up if somebody has a four grams hemoglobin in any setup one would be interested to know what is the cause but a hemoglobin of ten one can play around at in the rural setup for four grams i would go and straight for investigation and today everything is connected i mean there's hardly an area it's only a matter of people picking up early i would tend to believe that picking up anemia in a rural area is more difficult because of various presentations being the primary you know target of treatment so in rural areas if somebody comes with breathlessness the high level of suspicion for him hemoglobin would not be there and therefore delaying diagnosis is a bigger problem management is i don't think is a problem okay and so how do you suspect milo this plastic anemia in a given patient any surrogate markers apart from bone marrow biopsy other yes bone marrow biopsy is diagnostic we are talking the question very nice is about how would you suspect myelodysplasty when you do a cbc count a repeated low hemoglobin with a low rbc count and a low platelet count and you do a peripheral smear no signs of hemorrhage but you find anisocytosis and pychlocytosis in the rbcs one and age group of beyond 70 one should suspect myelodysplastic anemia no time to be wasted for a bone marrow so at what levels do we really need for prbc transfusion well again there is as i said every individual has to be assessed if somebody comes to the serum iron concentration of 25 or in 15 i've seen as low as 15 serum iron and you see signs of hemorrhage i would go in for a transfusion straight away because you got to the avoid the person developing co-morbidities because of anemia so every individual will vary if somebody's just got a hemoglobin of six with no other features of co-morbidity and can tolerate orange i will go in for oral first so every individual there is no cut off point it is cut off features associated with the low hemoglobin which make the decision and so what is your view in approach to aplastic anemia well hyplastic anemia is the the cause has to be found out whether it was medical or it is uh you know the cause of aplastic anemia investigated there is no individual variation in approach the aplastic anemias again have an algorithm and one has to approach it according to the algorithm prescribed in a case of a aplastic anemia there is no choice you can't say okay i'll give blood transfusion to dinner see these individual choices and anemia should not be taken up so what are the home remedies for anemia eat well stay happy i'm sure the question is pointed towards the foods which are available and considered to be as a treatment for anemia yeah because elderly people don't really want to go through the treatment well again it depends on the condition of the if elder is god he is in a state of congestive heart failure are you going to tell such an elder person you might well meet him at the cremation ground so what is important the foods which are rich in iron are eggs and fish and non-vegetarian material the green leafy vegetables which are considered high in folates more than iron are facilitators of iron absorption mixture of pulses can facilitate absorption of iron and in elders even issues like absence of teeth because they don't masticate well there is lack of absorption of iron so in elderly it is not always the lack of food but there are many associated issues that cause iron deficiency so you can't a diabetic elderly who's borderline say even a hp1c of eight you can't afford to tell them to have so much of good so it is better to give supplements straight away rather than tell them to try food therapy for improving their iron it's too risky so how do you calculate oral iron or vitamin b12 dose no you don't calculate the oral it is oral iron in the fixed dose of more than 100 milligrams of elemental iron and it is given problem with oral iron is tolerance of the person there is incidences where oral iron can cause a lot of constipation and in elders because of hard stools they can cause a problem but there's no variation in dose in oral therapy okay and so are there any mobile equipments to check hemoglobin well those are these days certain companies have come out with machines and you can do hemoglobin with them and they give you instant results they are available okay and so any drugs to treat hyper hemoglobin conditions why drugs find out why they are if somebody has polycythemia you must know why it is you don't treat it unless there is a cause somebody comes with a hemoglobin of 17 there is no medication to reduce that so can anemia cause silent heart attack in elderly horse of course of course one of the uh causes for silent mis or angina is anemia with iron deficiency it is an established cause and it has been proved that once you correct their iron deficiencies they're because it's logical it's physiological because of low hemoglobin their blood volume increases and in a compromised heart when the volume increases the heart can't take up that extra volume so the moment the hemoglobin gets corrected the blood volume goes down and the load decreases on the heart and so how common is angiodysplasia in the gut as a cause of iron deficiency anemia and elderly how common is angiodysplasia of gut i'm not aware okay and so uh can you suggest other signs regarding anemia in elderly except conjunctival pallor well in elderly i said all the symptomatology of breathlessness the conjunctiva color is a sign in elderly the others clinical signs to find out anemia may be pallor on the skin nails and dryness of the skin i wouldn't think of anything more than that as signs complaints of course we've discussed so if iron supplements are taken they can cause mileena how to overcome them no well the the the word melina is not for iron iron causes black stools because of discoloration now iron melina is because of interstellar bleeding oral iron therapy cannot cause intestinal bleeding so it is not melina it is discoloration of those two now if somebody has an existing bleeding i would first treat the bleeding in the intestine as i said in my slide first treat the comorbidity if you have diagnosed internal bleeding as a cause of anemia correct the bleeding before you give oral therapy such a person if a low has very low iron if somebody has bleeding as a cause of anemia and the iron is somewhere in the range of 20s and 30s such a person if he does not have a cardiac issue is fit for iv iron therapy whereas if he's in so first correct the the blood loss then see the cause of the bleeding is it hydrogenic is it because of aspirin causing bleeding in the elderly to starting the serum iron estimation probably has been done once the oral therapy is started within three weeks time the iron concentration should rise how much it rises is not important if 20 say 25 you okay you are on track the person is tolerating with the report which shows increased anemia uh sigma iron concentration is good enough answer what options is injectables okay and can iron and calcium take simultaneously should not should not drug induced hemolytic anemia criteria what is the most important diagnostic your blood pressure if there is whether it is drug induced or whether it is abc induced the parameter for diagnostic of hemorrhagic anemia hemorrhagic anemia drug induced himalayas in india the features of hemolytic anemia are decreased blood count rbc count mcb mch low and a high pcb so these features show you hemolysis now whether it is drug induced or not that is a clinical judgment the drug induced humanity picture doesn't change because of drug induced or any any other cause of hemolysis you are assessing the hemolytic picture not you can't get a drug in a our blood count sir is obesity related with anemia well both are very common in indians and so therefore you can say well they are not kazakhstan's relationship it does not that obesity causes anemia they are found commonly and a person a person who is will tend to have certain comorbidity issues so frequent beverages like coffee or tea causes iron deficiency anemia and elderly people well see the questioner has to understand tea coffee how will it cause anemia if a person has a hypogastrics you know layer covering has frequent acidity has an erosive gastritis then tn coffee increases the erosive gastritis now if that gastritis increases the absorption can go down in the small gut so there's no direct effect of tea and coffee on anemia or iron metabolism it is that existing pre-existing condition can get worsened by tea and coffee that's all uh so how do we treat anemia and elderly population at community level why do you want to treat at a community level are you trying to ask me that why don't we put iron into the municipal corporation tank of water and ask all elders to get it it's a community level i i would switch the question i would switch the question and say what community initiative can be taken to manage anemia yes that is important it has to be a community initiative i agree with you and the community initiative is ask every elder beyond 65 years of age to get their hemoglobin and serum iron tested if either of them are found below 12 or 13 male or female or serum iron is below 50 get yourself examined get yourself tested that is the community project the government of india's anemia is a community project i would love to see doctors participate in resident welfare association with a banner and say anemia mukbharat i am here to advise you how to do anemia six by six by six i'm ready to support everybody stand with the banner and say please get your hemoglobin and serum iron done that's a community initiative so in adolescence many girls having anorexia nervosa can be a cause of anemia why not when you have diagnosed the person has anorexia nervosa in which anorexia nervosa results in poor eating so when there is a diagnosis already established anemia can be followed and so your opinion about the use of lyfolyzed form of iron as their gi absorption tolerances which one yeah well again today the standard treatment for oral iron is the 100 milligrams formulations whether it is lyfolized or not doesn't make a difference the absorption is depends on the x the amount of b12 in the body and the folic acid that is more important thank you

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Dr. Murtuza Zozwala & 1478 others

SPEAKERS

dr. G.S. Grewal

Dr. G.S. Grewal

Senior Consultant- Elder Care, Fortis Escorts Hospital | President Indian Medical Association, Delhi 21-22 | Chairman - Wellness Health & You | Honorary Secretary, Age-Care India

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dr. G.S. Grewal

Dr. G.S. Grewal

Senior Consultant- Elder Care, Fortis Escorts...

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