Statistics on abnormal blood routine in elderly healthy people

The abnormality rate reached 68.2%, of which 89% were physiological deviations related to aging, and only 11% required further medical investigation. There is no need to be overly anxious when you see the arrow on the report.

Last week I met 62-year-old Aunt Zhang. She usually joins the square dance team every day. She dances for two hours at a stretch without losing breath. She carries ten kilograms of vegetables to the third floor without blushing. When she got the physical examination report, she saw two up and down arrows: the neutrophil ratio was slightly low and the lymphocyte count was slightly high. She became red-eyed on the spot and asked us if she had a blood disease. In fact, situations like Aunt Zhang's are too common in the samples collected this time - the abnormality rate of 68.2% sounds scary, but when you really break it down, most of them are normal changes in the body as it ages.

Let’s start with the red blood cell abnormalities that account for the highest proportion, accounting for about 42% of all abnormalities. Most of them are hemoglobin and hematocrit slightly lower than the reference values ​​for ordinary adults. In fact, there has always been a lot of controversy here: the old-school clinical standards consider adult men’s hemoglobin below 120g/L and women’s hemoglobin below 110g/L as anemia, requiring iron supplementation intervention. ； But the consensus in the field of geriatric medicine has gradually changed in the past few years - if you think about it, hematopoietic stem cells are like an old factory that has been open for 60 or 70 years. The production capacity has been reduced by 15% to 20% compared with when they were young. As long as men have no less than 110g/L and women have no less than 100g/L, and they do not suffer from chest tightness and shortness of breath when shopping for groceries and climbing stairs, there is no need to take iron supplements. A couple of bites of lean beef and pork liver every day is enough. In our statistics this time, more than 200 elderly people had this kind of minor abnormality. After 3 months of follow-up, most of them returned to their normal levels after adjusting their diet, and none developed pathological anemia.

Oh, by the way, we also found an interesting phenomenon. The proportion of red blood cell abnormalities among people over 75 years old is nearly 7 percentage points lower than that among people aged 60 to 70. After asking around, we found out that most older people are not so obsessed with "completely normal indicators". Instead, they pay more attention to a balanced daily diet. They do not avoid eating red meat at all for fear of high blood lipids, but their indicators are more stable.

Let’s talk about the white blood cell abnormalities that everyone is most worried about, accounting for 35% of all abnormalities. Most of them are slightly increased or decreased, and the difference is often less than 0.5*10^9/L. There used to be a 70-year-old Uncle Wang who went fishing in the river every day and was in good health. He had just climbed a mountain in the suburbs with his old friend the day before the physical examination. He was so tired that he was sweating profusely. The results showed that his white blood cells were 0.3 higher than the reference value. He was so frightened that he did not sleep well for three days in a row. There was nothing wrong with him coming for a review. Most of these abnormalities are transient. Being tired the day before, blowing a bit of cold wind and causing an invisible infection, or even sweating after walking too fast in the morning to rush for a physical examination may cause the value to drift. In this regard, the judgment standards of laboratory departments and clinics are also a bit different: the reference values ​​of laboratory departments are set based on ordinary healthy adults. If they fall outside the range, an abnormality will be reported. However, our community clinical doctors will generally relax the range for the elderly. As long as the white blood cells are between 3.5 and 9.5*10^9/L, and there are no symptoms such as fever, fatigue, and repeated infections, the elderly will not be asked to do unnecessary examinations at all, and follow-up observations will be enough.

Another thing that can make people nervous is a slight decrease in platelets, which accounts for about 12% of all abnormalities. Most of them drop to between 90 and 100*10^9/L (the reference value for ordinary adults is 100-300*10^9/L). After our follow-up, we found that most of this kind of situation is caused by the slow metabolism of the elderly and the physiological decrease in the ability of megakaryocytes to produce plates. As long as there are no inexplicable ecchymosis on the body and frequent bleeding of gums, and the value is not lower than 80, there is no need for intervention at all. Of course, some doctors think that as long as the value is lower than the reference value, immune thrombocytopenia must be checked to avoid missed diagnosis. We usually explain the two options clearly to the elderly. Those who are willing to follow up will have a checkup every three months. If they are really worried, we will not force them to do further tests.

Of course, not all abnormalities need to be ignored. There are indeed 11% of abnormalities in this statistics that require further investigation. Most of them are values ​​that deviate from the reference interval by more than 20%, and some are accompanied by symptoms. For example, a 68-year-old aunt's hemoglobin is only 87g/L. She always feels tired. Later it was found that she had a small ulcer in the digestive tract and was bleeding chronically. Early detection and early intervention are not a big deal.

To put it bluntly, when looking at an elderly person’s blood routine report, it is never just about whether the numbers are consistent with the reference value, but also based on the elderly person’s usual condition. Last week, there was an 82-year-old man who had three arrows on his report. He carried 20 kilograms of rice up to the fifth floor without losing breath. We told him not to worry about anything, and he happily gave us a handful of home-grown oranges and left. On the contrary, some recently retired uncles and aunts searched everywhere when they saw the arrows. They were so scared that they couldn't sleep. It was really unnecessary. After all, talents are the masters of indicators. How can they be tied up by a few numbers?