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Anemia is a common diagnosis in the geriatric population, especially in institutionalized and hospitalized elderly. Most common etiologies for anemia in elderly people admitted to a geriatric ward are iron-deficiency anemia and anemia associated with chronic disease. Determination of serum ferritin is the most used assay in the differential diagnosis, despite low sensitivity and moderate specificity. New insights into iron homeostasis lead to new diagnostic assays such as serum hepcidin, serum transferrin receptor and reticulocyte hemoglobin equivalent.Importance of proper diagnosis and treatment for this population is large since there is a correlation between anemia and morbidity - mortality. Anemia is usually defined as hemoglobin less than 12 g/dl for women and less than 13 g/dl for men. There is no consensus for which hemoglobinvalue an investigation into underlying pathology is obligatory. This needs to be evaluated depending on functional condition of the patient.

The practice guideline of the Royal Dutch Organization of Midwives 'Anaemia in primary care midwifery practice' published in 2000, has recently been revised. The revised guideline takes physiological haemodilution during pregnancy into consideration and provides gestation specific reference values for haemoglobin levels. The guideline advises to start iron supplementation only in demonstrated iron deficiency based on low levels of haemoglobin and mean corpuscular volume (MCV). This results in less prescription of iron medications and prescription of lower dosages, which will result in fewer adverse effects and better therapy adherence. New chapters are added concerning anaemia during preconception and the puerperium. More attention is given to women with an increased risk of anaemia in pregnancy and the influence of a positive carrier status for haemoglobinopathy. In order to achieve good continuity of care, collaboration between obstetricians and general practitioners is important.