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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