Anemia in the elderly always reflects a pathological process. Neurological or cardiovascular signs are frequent at diagnosis. Iron deficiency anemia or anemia of chronic disorders are the common causes. The incidence of refractory anemia increases with age. The biological diagnostic workup is not always successful and low dosages of vitamin B12 or folates are not necessarily associated with anemia. Anemia in the elderly is in most of cases a multistep process, and current classification not easy as in younger patients.