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10 Cards in this Set
- Front
- Back
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Aging and hematopoiesis
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Healthy older patients should not have a drop in blood counts
Marrow can sustain normal peripheral blood counts throughout the human lifespan, but… Diminished reserve capacity in times of stress Abnormal complete blood count is pathologic, not physiologic and SHOULD be evaluated |
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Causes of anemia in elderly
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Iron deficiency 20%
Anemia of chronic disease (ACD) or anemia of inflammation 20-25% Chronic kidney disease B12 or folate deficiency Note: Unexplained anemia (up to 30%) |
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Iron deficiency vs ACD
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Iron deficiency anemia
-Ferritin low ACD -Ferritin normal to increased |
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Clinical associations of anemia in elderly
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Hemogloblin lower than 12 increases mortality hazard
Cardiac disease Decreased muscle mass and strength Increased disability Increased falls and fractures Associated with cognitive impairment May be the first sign of underlying serious illness May be an independent cause of morbidity and mortality |
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Theories of carcinogenesis in aging
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Longer duration of carcinogen exposure
Decreased DNA repair ability Increased genomic instability Decreased tumor suppressor activity Decreased immune surveillance |
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Older adults and chemo outcomes
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Population statistics consistently demonstrate decreased survival in adults >65
-Patients >65 are 16 times more likely to die of disease Older adults experience increased toxicity related to treatment |
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Research/treatment bias in treatment for older adults
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Older adults are not well represented in clinical trials
-poor generalizability due to selection bias Referral bias -not screened as much Treatment bias -not given as aggressive of treatment -up front dose attenuation Some older patients don't consider chemo |
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Age related changes in tumor biology
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Have more unfavorable acute leukemias and NHL
-prior MDS -more Ph+ -more MDR |
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Age related changes in pharmacology
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Decreased intestinal absorption
-bioavailability Decline in renal excretion -increase toxicity Changes in volume of distribution -increase toxicity Altered metabolism by P450 -impaired activation or elimination |
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Treatment decision
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Characteristics of tumor
Characteristics of treatment Characteristics of patient |
