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7/27/2019 Hematological Disorders in Geriatric Patients
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Hematological Disorders
in Geriatric PatientsA.Fachruddin Benyamin
SubDiv of Hematology & Medical Oncology
Dept of Internal Medicine, Medical Faculty
Hasanuddin University
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I. Introduction :
Specific disorders/diseases in geriatric
Related to aging process, natural &
physiologically
Specific health problems
Should be managed properly
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II. Age & Diseases Relationship :
Evidence :
1. Degenerative diseases
2. Bone & Joint diseases
3. Malignancy
4. Others
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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.
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IV. Hematological Disorders
in Geriatric Patients :
1. Iron defc Anemia
2. Megaloblastic Anemia
3. Chronic Lymphocytic Leukemia
4. Multiple Myeloma
5. Myelodysplastic Syndrome
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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
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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- Hypothermia (< T4 T3)
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2. Megaloblastic Anemia
a : B12 defc & Folate defc
(Gastrectomy,malabsorption,diverticle,
Crohn disease, lymphoma,drugs etc.)
Hyperthyroidism, malignancy
b : Pernicious anemiaPeak : 60 y.o
Auto-immune,atrophy (achlorhydria)
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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)
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4. Chronic Lymphocytic Leukemia
CLL : Most often found leukemia in USA.
Mostly > 60 y.o.
90 % > 50 y.o.
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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
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MDS :
Median age : male 74,1 y.o
female 78,2 y.o
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6. Multiple Myeloma
MM : malignant growth of plasma cell.
Median age : 62 y.o.
Abnormal plasma cell secreting mono-
clonal Ig (in serum & urine)
1. Bone-marrow failure
2. Increased plasma volume
3. Increased plasma viscosity
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MM :
4. Supressed normal Ig production
5. Bone destruction bone-pain etc.
6. Kidney function disorder
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Thank You