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HEMATOLOGICAL DISORDERS

IN GERIATRIC PATIENTS

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)
THE ROLE OF CYANOCOBALAMIN

1. Methyl-Cobalamin is a cofactor for methionine-


synthetase at rx change of homosystein  metyonin.
2. Adenosyl-Cobalamin is a cofactor at rx change of
methyl-malonyl CoA  succinyl-CoA
Macrocytic Normocytic
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.
INTRODUCTION :
• Chronic Myelogenous Leukemia ( CML )
- Belongs to Myeloproliferative Disorders
- Adult & elderly
- Relatively slow clinical progression
- Relatively better live expectancy than acute
leukemia.
CLINICAL PICTURE OF CML :
• Adult & elderly
• Male > female
• Splenomegaly ( Schuffner VII / VIII )
• Sometimes hepatomegaly
• Complaints : abd. fullness/dyspneu
abdominal mass
early satiety
CLINICAL PROGRESSION IN CML :
• I. ChronicPhase
relatively stabil, lasting months / years
• II. Accelerated Phase
decreased clin condition, weeks /months
blood smear : increased of blast cells
• III. Blast Crisis Phase
worsened condition & laboratory findings
as an acute leukemia
PATHOGENESIS OF CML :
• Majority : Philadelphia chromosome (+)
• t (9:22) : resiprocal transversion of genetic material
from chrom 9 to 22 (vv)
 new abnormal protein
 initiating abnormal proliferation of myeloid cells
in bone-marrow  CML.
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 74,1 y.o
female 78,2 y.o
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
MM :
4. Supressed normal Ig production
5. Bone destruction  bone-pain etc.
6. Kidney function disorder
THANK YOU

BABEL MAROS