**7. Grade of anemia**

WHO classified anemia as public health problem in 2008 into mild, moderate and severe category [72]. Most common grade appreciated is mild (57.1%) with mild to moderate anemia commonly affecting females.While severe and life-threatening anemia is confronted in males predominantly [73]. As greater part of the patients are mild anemia only, foremost findings are difficult to observe even pale conjunctiva usually noted when Hb level drops below 9 gm/dL [32]. So this may be the reason that patients of this grade go unnoticed. For example in a study conducted on 1,146 community-dwelling older females it was found that women with Hb levels of 12 to 13 gm/dL perform worse than women with Hb levels of 13 to 15 gm/dL on tests of walking speed, balance and ability to raise from a chair [74]. Across-sectional study including 334 elderly persons was conducted by Pathiana A and fellows in old age home. The overall prevalence of anemia was found to be 68.7%, 47.4% had mild anemia, 47.0% had moderate anemia and 5.6% had severe anemia with 45% of men with mild anemia as compared to 24.8% in women [30].

It has been suggested in the literature that a diagnostic algorithm should be followed and anemia should be classified with a therapeutic orientation. Supplements of iron, micronutrients and erythropoiesis-stimulating agents should constitute the treatment [75].
