Takubo T, Tatsumi N
Department of Clinical and Laboratory Medicine, Osaka City University Medical School.
Rinsho Byori. 2000 Mar;48(3):207-16.
The establishment of reference values in the complete blood count and lymphocyte subsets for the aged is necessary for diagnosis and therapy since the number of the aged is increasing rapidly in recent years. However, it is problematical to define the healthy aged because of physiological changes with aging, compared with the healthy adults. Red blood cell count, hemoglobin concentration(Hb) and hematocrit for the healthy aged showed the tendency of moderate decreasing with aging. These phenomena become more obvious by dividing the healthy aged into three groups, 65-74 years, 75-84 years and over 85 years. The mean corpuscular volume(MCV) for the healthy aged showed the tendency of increasing with aging, while mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration for the healthy aged showed no tendency with aging. No changes for the healthy aged were observed in the leukocyte differential, white blood cell count and platelet count with aging. Results of lymphocyte subsets(CD3, CD4, CD8, CD19 and CD4/CD8 ratio) for the healthy aged are not coincident among reporters at present because the healthy aged population is different and the determination of lymphocyte subsets is not standardized. It is important to diagnose as anemia below Hb 11.0 g/dL between 65 and 74 years, Hb 10.0 g/dL over 75 years using Hb level with high accuracy. Most of hematologic disorders in the aged are the secondary anemia based on malignant tumor. In the aged between MCV 95 and 120 fL or over MCV 120 fL, myelodysplastic syndrome or vitamin B12 deficiency is considered, respectively. In the future, more vertical study in the aged population is needed to establish the reference values for the aged.
近年来,老年人数量迅速增加,因此建立老年人全血细胞计数和淋巴细胞亚群的参考值对于诊断和治疗至关重要。然而,与健康成年人相比,由于衰老带来的生理变化,定义健康老年人存在问题。健康老年人的红细胞计数、血红蛋白浓度(Hb)和血细胞比容显示出随年龄增长而适度下降的趋势。将健康老年人分为65 - 74岁、75 - 84岁和85岁以上三组后,这些现象变得更加明显。健康老年人的平均红细胞体积(MCV)显示出随年龄增长而增加的趋势,而健康老年人的平均红细胞血红蛋白和平均红细胞血红蛋白浓度则没有随年龄增长的趋势。健康老年人的白细胞分类、白细胞计数和血小板计数在衰老过程中未观察到变化。目前,不同报告者关于健康老年人淋巴细胞亚群(CD3、CD4、CD8、CD19和CD4/CD8比值)的结果并不一致,这是因为健康老年人群不同且淋巴细胞亚群的测定不规范。准确使用Hb水平诊断65至74岁Hb低于11.0 g/dL、75岁以上Hb低于10.0 g/dL的贫血很重要。老年人的大多数血液系统疾病是基于恶性肿瘤的继发性贫血。对于MCV在95至120 fL之间或MCV超过120 fL的老年人,分别考虑骨髓增生异常综合征或维生素B12缺乏症。未来,需要对老年人群进行更多纵向研究以建立老年人的参考值。