Hematological Disorders in Geriatric Patients

Dr.Tutik Harjianti SpPD

SubDiv of Hematology & Medical Oncology Dept of Internal Medicine, Medical Faculty Hasanuddin University

I. Introduction :

Specific disorders/diseases in geriatric Related to aging process, natural & physiologically Specific health problems Should be managed properly

II. Age & Diseases Relationship :

Evidence : 1. Degenerative diseases 2. Bone & Joint diseases 3. Malignancy 4. Others

III. Basic Concept of Aging :

a. Genetic process b. Somatic mutation error in transcription & translation process c. Immune system defect d. Free radicals cell destruction tissue destr organ destr.

IV. Hematological Disorders in Geriatric Patients :

1. Iron defc Anemia 2. Megaloblastic Anemia 3. Chronic Lymphocytic Leukemia 4. Multiple Myeloma 5. Myelodysplastic Syndrome

Aging in Hematopoetic System :

Bone marrrow : dynamic elements Production & replication continously Old age : involution of BM decrease of BM reserve Cause : - micro-environmental - humoral factors

1. Iron Defc Anemia

Cause : chronic blood-loss (mostly) G I tract - ulcer,varices,colorectal,malign. - drug ( ASA, NSAID) Effects : - Decrease of working capacity - Predisposition to infection

2. Megaloblastic Anemia

a : B12 defc & Folate defc (Gastrectomy,malabsorption,diverticle, Crohn disease, lymphoma,drugs etc.) Hyperthyroidism, malignancy b : Pernicious anemia Peak : 60 y.o Auto-immune,atrophy (achlorhydria)

3. Leukemia
AML : 80 % adult age Median age : 55 y.o. Increase of incidence = age Problem : - Poor prognosis - Low remission rate (low tolerance to chemotx, infection etc)

4. Chronic Lymphocytic Leukemia

CLL : Most often found leukemia in USA. Mostly > 60 y.o. 90 % > 50 y.o.

5. Myelodysplastic Syndromes

MDS : abnormal proliferation of single clone in bone-marrow. Defects : maturation & proliferation BMP : usually hypercellular Peripheral blood smear : cytopenia Clinic : anemia,infection,bleeding MDS may progresses to Acute Leukemia

MDS :

Median age : male female

74,1 y.o 78,2 y.o

6. Multiple Myeloma

MM : malignant growth of plasma cell. Median age : 62 y.o. Abnormal plasma cell secreting monoclonal Ig (in serum & urine) 1. Bone-marrow failure 2. Increased plasma volume 3. Increased plasma viscosity

MM :

4. Supressed normal Ig production 5. Bone destruction bone-pain etc. 6. Kidney function disorder

Thank You