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Immune Hemolytic Anemia in the Aged
Symposium on Hematologic Disorders
Immune Hemolytic Anemia in the Aged
]amshid ]avid, M.D. *
Anemia is a common finding among the elderly. When present, it should be regarded as an indication of underlying disease, not as a physiologic outcome of senescence. 32 The clinical evaluation and management of anemia in the older patient is substantially similar to that in the general population. There are, nevertheless, notable differences in the prevalence of certain disorders, in the ability of the patient to tolerate the consequences of anemia, and in the safety of particular therapeutic measures. Blood loss, inadequate red cell production, and hemolysis, alone or in various combinations , are the general pathways by which anemia develops. A previously undiagnosed hemolytic anemia in the older patient is most likely to be of the acquired type, of which immune hemolytic anemias constitute a large fraction. Their presence can usually be suspected on clinical grounds and, in the vast majority, readily confirmed by simple laboratory tests. Several extensive reviews and monographs dealing with immune hemolytic anemia are available. In particular, Dacie's classic treatise, 15 the extensive monograph by Pirofsky, 72 and the more recent book by Petz and Garratty 71 are rich sources of clinical and technical information. The present brief review will deal with the classification, pathophysiology, clinical manifestations, and the general principles of management of the immune hemolytic anemias. Although the overall approach is from the clinical perspective, certain basic aspects are emphasized because they correlate with and help to rationalize the clinical features of the various diseases discussed. *Associate Professor of Medicine, Department of Medicine, Division of Hematology, New York University Medical Center, New York, New York Supported by National Institutes of Health Grant RR 05399.
Clinics in Geriatric Medicine-Vol. 1, No. 4, November 1985
747
J
772
}AMSHID }AVID
103. Wortman, J., Rosse, W., and Logue, G.: Cold agglutinin autoimmune hemolytic anemia in non-hematologic malignancies. Am. J. Hematol., 6:275-283, 1979. 104. Yonet, H. M., Vigliano, E. M. , and Horowitz, H. I.: Acute hemolytic anemia associated with administration of alkylating agents: Report of two cases due to cyclophosphamicle and review of the literature. Am. J. Med. Sci., 254:70--77, 1967. 105. Zucker, S., Lysik, R. M., and DiStefano, J. F.: Cancer cell inhibition of erythropoiesis. J. Lab. Clin. Med. , 96:770--782, 1980.
Division of Hematology Department of Medicine New York University Medical Center 550 First Avenue New York, New York 10016
Immune Hemolytic Anemia in the Aged
]amshid ]avid, M.D. *
Anemia is a common finding among the elderly. When present, it should be regarded as an indication of underlying disease, not as a physiologic outcome of senescence. 32 The clinical evaluation and management of anemia in the older patient is substantially similar to that in the general population. There are, nevertheless, notable differences in the prevalence of certain disorders, in the ability of the patient to tolerate the consequences of anemia, and in the safety of particular therapeutic measures. Blood loss, inadequate red cell production, and hemolysis, alone or in various combinations , are the general pathways by which anemia develops. A previously undiagnosed hemolytic anemia in the older patient is most likely to be of the acquired type, of which immune hemolytic anemias constitute a large fraction. Their presence can usually be suspected on clinical grounds and, in the vast majority, readily confirmed by simple laboratory tests. Several extensive reviews and monographs dealing with immune hemolytic anemia are available. In particular, Dacie's classic treatise, 15 the extensive monograph by Pirofsky, 72 and the more recent book by Petz and Garratty 71 are rich sources of clinical and technical information. The present brief review will deal with the classification, pathophysiology, clinical manifestations, and the general principles of management of the immune hemolytic anemias. Although the overall approach is from the clinical perspective, certain basic aspects are emphasized because they correlate with and help to rationalize the clinical features of the various diseases discussed. *Associate Professor of Medicine, Department of Medicine, Division of Hematology, New York University Medical Center, New York, New York Supported by National Institutes of Health Grant RR 05399.
Clinics in Geriatric Medicine-Vol. 1, No. 4, November 1985
747
J
772
}AMSHID }AVID
103. Wortman, J., Rosse, W., and Logue, G.: Cold agglutinin autoimmune hemolytic anemia in non-hematologic malignancies. Am. J. Hematol., 6:275-283, 1979. 104. Yonet, H. M., Vigliano, E. M. , and Horowitz, H. I.: Acute hemolytic anemia associated with administration of alkylating agents: Report of two cases due to cyclophosphamicle and review of the literature. Am. J. Med. Sci., 254:70--77, 1967. 105. Zucker, S., Lysik, R. M., and DiStefano, J. F.: Cancer cell inhibition of erythropoiesis. J. Lab. Clin. Med. , 96:770--782, 1980.
Division of Hematology Department of Medicine New York University Medical Center 550 First Avenue New York, New York 10016