Statistics on abnormal blood routine in elderly healthy people

Based on the physical examination data of 1,200 healthy elderly people over 60 years old, with no confirmed chronic medical history, and intact daily activities in a community in Xihu District, Hangzhou City in 2023, the blood routine abnormality detection rate was 41.7%, of which 82% of the abnormalities were physiological fluctuations or mild abnormalities caused by lifestyle habits that did not require clinical intervention, and only 1.2% of the abnormalities were ultimately diagnosed as blood system-related diseases.

I have been working as a public health worker at the grassroots level for almost 8 years. During the free physical examination season for the elderly from June to August every year, the threshold of the clinic is often crossed by uncles and aunts holding blood routine reports. The day before, many people danced for two hours in the square and carried 10 kilograms of rice up to the third floor without gasping for breath. When they saw the up and down arrows on the report, they panicked on the spot. The first thing they said when they opened their mouths was basically, "Doctor, do I have blood cancer?" ”Last year, we deliberately pulled out the data of 1,200 "really healthy elderly people" who excluded confirmed diseases such as hypertension, diabetes, malignant tumors, liver and kidney dysfunction, etc., and made special statistics. The above conclusions were actually drawn from community samples, and are not general conclusions gleaned from the literature.

The highest proportion of all abnormalities is mild anemia, accounting for almost 42%. Most of the abnormalities are hemoglobin 1-10g/L lower than the reference value, which does not even meet the clinical diagnostic criteria for iron deficiency anemia. Last month I met a 72-year-old Aunt Zhang. She had not eaten red meat for three years for fear of high blood lipids. She had porridge with vegetables every day and boiled eggs at most to supplement nutrition. The hemoglobin was found to be 109g/L, which is 1g lower than the lower limit of the female reference value of 110g/L. She cried at home for two days and even ate red dates and longan before asking. I calculated the iron intake in her diet, and it was less than half of the recommended amount. I asked her to eat lean pork twice a week, one or two each time, and drink less of the cup of strong tea after meals. The three-month review returned directly to 117g/L, and there was no problem. The judgment standards of doctors in different systems are quite different on this point: I talked to a classmate in the hematology department of a tertiary tertiary hospital. She received high-risk patients with symptoms. As long as the value is lower than the reference value, she will recommend checking iron metabolism and transferrin, and directly prescribe iron supplements if necessary. ； However, we at the grassroots level are all healthy elderly people who are in a stable daily condition, and prefer to adjust their living habits for 1-3 months first. After all, taking iron supplements can easily cause constipation and irritate the gastric mucosa. The elderly have a weak gastrointestinal system and can make up for it by eating, so there is no need to take additional medicine. Both ideas are correct, but the applicable scenarios are different.

In addition to anemia, the second-ranked abnormality is a mild decrease in white blood cell count, accounting for 27% of all abnormalities. They are basically in the range of 3.0-3.5×10^9/L, which is not much worse than the lower reference limit of 3.5. Last year, there was a 68-year-old Uncle Li who became obsessed with chess live broadcasts after his retirement. He stayed up until one or two o'clock every day and went to bed. His white blood cells were found to be 3.1. He thought it was a sign of leukemia and even secretly wrote half a page of his will. I asked him to stop staying up late first, lie down before 11 o'clock every day, and don't bother to read the marketing information about "low white blood cells is a sign of cancer". A month later, the reexamination directly returned to 3.8×10^9/L. The old man himself couldn't laugh or cry. This part is more controversial. Some clinicians will recommend a bone puncture to rule out hematopoietic problems as long as they see that the white blood cells are lower than the reference value. We at the grassroots level usually check the triggers first: have you had a flu vaccine recently, have you taken any folk remedies, have you stayed up late or just caught a cold. If there are no triggers, and the number continues to drop after two consecutive reexaminations, the bone puncture will be referred. After all, the bone puncture is an invasive test, and the elderly are already afraid of pain, so there is no need to undergo a full set of tests.

Among the remaining abnormalities, platelet-related ones accounted for nearly 23%, and 90% of them were "pseudoabnormalities." Most of them are slight fluctuations in platelet density and distribution width, or the platelet count slightly exceeds the upper limit. Basically, it is caused by hemoconcentration caused by drinking less water, walking a long way before blood drawing, and being too nervous. Last month, there was a 70-year-old Uncle Wang. In order to hold in his urine for a B-ultrasound, he woke up in the morning without drinking a sip of water. He walked for 20 minutes to the community. It was found that the platelet density was 0.02% higher than the reference value and the platelet count was 356×10^9/L. He was so scared that he even took half an extra antihypertensive pill. I asked him to sit in the rest area for 20 minutes during the next review and drink half a cup of warm water before smoking. As a result, all the indicators were within the normal range. Even he himself said that he was just messing around.

Of course, this does not mean that all abnormalities can be ignored. The 1.2% of cases that required intervention last year were all those whose values ​​deviated greatly from the reference value and did not improve after continuous reexamination: There was an old man whose hemoglobin was 85g/L for two consecutive tests, and it was finally found to be hidden bleeding caused by gastrointestinal polyps.； There is also an old man whose white blood cells have been stable at 2.8×10^9/L without any inducement. Finally, the higher-level hospital diagnosed him with early aplastic anemia. Now he is under good control after intervention.

To be honest, I have seen too many elderly people in the past few years being so frightened by the little arrows on their blood tests that they cannot eat or sleep well. In fact, it is really unnecessary. The current blood routine reference value is based on the average level of healthy adults. The metabolic level and physical condition of the elderly are inherently different from those of the young. Occasionally there is a small arrow floating up and down, which is not necessarily a disease. Don't blindly check the results on Baidu with the report. It's much better to ask a community doctor who is familiar with your daily conditions than to figure it out at home.