With the aging of the baby boomer population and the growth in underwriting older age applicants for life insurance, it no longer uncommon to see a larger number of diagnosed anemia cases.
Therefore, financial advisors and brokers need to be aware of this condition. The first part of this article reviews key facts about anemia, drawn from medical literature and personal interviews with various medical professionals. This is followed by a look at how various forms of anemia fare in the life underwriting process.
As with other impaired risk cases, the producer needs to become familiar with the condition, obtain relevant medical history and develop the underwriting information.
Anemia is a blood disorder and is defined as a reduction in the oxygen capacity of the blood resulting in a lowered red blood cell count or reduced Hematocrit (Hct) and/or Hemoglobin (Hgb). The production of red blood cells in adults occurs in the bone marrow stemming from a hormone produced by the kidneys.
Although anemia can be a single isolated diagnosis, it often can be accompanied by various other hematological factors such as iron deficiency. On a more severe scale, anemia in correlation with myelodysplasia (MDS) is a pre-malignant disorder where the bone marrow produces an insufficient number of normal blood cells. MDS is most often found in adults over the age of 50.
In general, when any one of the following factors is present, anemia is the resulting diagnosis:
An increase in the destruction or breakdown of red blood cells (RBCs) occurs when they are removed from the blood circulation too quickly or at a higher rate than normal. Bone marrow, where new blood cells are produced, can’t keep up with the higher demand to produce new RBCs. This is also known as hemolytic anemia.
Often, hemolytic anemia is related to hereditary conditions. One of the most common forms is sickle cell anemia–the result of defective hemoglobin that forces red blood cells to assume a crescent or “sickle” shape.
Another form, Thalassemia, is not as common as sickle cell anemia. It is a disorder of the blood proteins not forming properly. That results in rendering the blood unable to carry oxygen.
There are also certain medications that cause the destruction or breakdown of RBCs. An example is some antibiotics that are used to treat infections.
Increased blood loss causing anemia may be the result of a number of factors such as internal bleeding from trauma or injury, gastrointestinal disorders such as ulcers, surgery, and the inability of blood to clot properly. Anemia also can be caused by heavy menstrual losses. The resulting factor is iron deficient anemia.
Oral iron supplements are often used to overcome and replace the deficiency. Generally, people over age 60 who are taking iron supplement treatments to maintain iron levels and who obtain normal Hgb and Hct values can overcome the deficiency and obtain stable hematological lab results.
An inadequate RBC count occurs when the body is unable to produce healthy RBCs to make up for the cells that have been destroyed. This occurs when elements necessary to produce RBCs are missing such as Vitamin B12, or iron.
Malabsorption is another factor, which can be a result of Crohn’s disease, limiting the ability of Vitamin B12 to be absorbed into the body.
RBCs, white blood cells and platelets make up the three major types of blood cells. RBCs deliver oxygen, white blood cells fight infection and platelets assist in clotting. When any of these three blood cell types are not developed properly or are insufficient in numbers, the result is myelodysplastic syndrome or MDS. Symptoms associated with MDS include weakness, sleepiness, frequent nosebleeds and bruising. MDS is often seen in the elderly, as the development of blood cells within bone marrow weakens. As a result, the condition may develop into an acute leukemia.
When underwriting anemias, or diseases of the blood as a whole, proper underwriting assessment is critical by first determining the cause.
However, as mentioned earlier, anemia can be an isolated diagnosis. Sometimes a cause may never be identified. In these instances, as long as hematological lab values show the Hct and Hgb are within normal range (Hct .34 and Hgb 12), generally there will be a very mild rating to possibly no rating at all.
Hemolytic anemia that results from the quick destruction of RBCs and the inability of new RBCs to be produced can be mild to moderately rated. If the cause were known, such as infection, drugs, etc., the rating would be determined due to the specific cause.
If the diagnosis were idiopathic or unknown, a more moderate rating would be in order.
Sickle cell anemia when seen in adolescent ages generally carries a moderate to high rating. In those over age 50, the rating is usually mild depending on the severity of the disease.
When anemia is associated with increased blood loss, certainly the factor resulting in the loss of blood should be considered. If the cause can be identified, then assessing the case for that particular cause would be in order. If the cause is unknown, and the Hct and Hgb are normal, the underwriter will assess a slight rating. Of course, if lab values are abnormal, it’s possible that underwriting of the risk will be postponed until further evaluation is investigated or hematological values return to normal.
Finally, an assessment of anemia when presented as a result of an inadequate RBC, such as Vitamin B12 deficiency or malabsorption, will depend on the treatment and how well recovery and continued treatment is controlled.
With blood counts returning to normal and adequate treatment, most likely a rating will not be necessary.
If blood counts have not returned to normal, and control has been interrupted, complications arise which would warrant postponing or possibly a declination of the risk.
MDS as a blood disorder and in correlation with anemia has a better prognosis in children than in adults. The ability for the bone marrow to produce healthy RBCs decreases at older ages and the possibility of a bone marrow transplant to correct the deficiency becomes an increased risk at these older ages. Unfortunately, these cases would be the most severe when related to anemia and would not be acceptable risks.
In sum, if a cause for anemia cannot be determined, lab values remain at abnormal levels or the applicant is simply undiagnosed, the risk would certainly be postponed or declined. It’s important to be aware and understand the cause for anemia and build from there.
Many impairments, which are related to anemia, are insurable with only slight to possibly no rating at all.
Elizabeth V. Cammarota is vice president at Brokerage Professionals Inc., Phoenix, Ariz. Her e-mail is email@example.com.
The producer needs to become familiar with the condition, obtain relevant medical history and develop the underwriting information
What To Look For
ü Increase in destruction or breakdown of red blood cells
ü Increased blood loss
ü An inadequate red blood cell count