Department of Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI.
Versiti Blood Center of Wisconsin, Milwaukee, WI.
Blood. 2024 Jan 18;143(3):214-223. doi: 10.1182/blood.2022017634.
Thrombocytopenia in older individuals is a common but diagnostically challenging condition that has variable clinical impact to those who are affected. Diagnostic approach requires evaluation of the preexisting clinical conditions, detailed review of medications, and assessment for disorders that warrant urgent treatment. In this article, we describe a systematic approach to diagnosis of thrombocytopenia and present a schematic review for management strategies. Three clinical scenarios are presented that are relevant for their prevalence and management challenges in an older adult population. The first scenario addresses primary immune thrombocytopenia (ITP) and reviews different treatment options. The second one addresses complications of thrombocytopenia in management of the myelodysplastic syndrome. The last one reviews diagnostic challenges of drug-induced ITP.
老年人血小板减少症是一种常见但具有挑战性的疾病,对受影响者的临床影响各不相同。诊断方法需要评估患者的既往临床状况、详细审查药物使用情况,并评估需要紧急治疗的疾病。本文描述了一种系统性诊断血小板减少症的方法,并提出了一个管理策略的示意图。本文提出了三种与老年人常见且具有管理挑战性的临床情况相关的情况。第一种情况涉及原发性免疫性血小板减少症(ITP),并回顾了不同的治疗选择。第二种情况涉及骨髓增生异常综合征中血小板减少症的并发症管理。最后一种情况综述了药物诱导的 ITP 的诊断挑战。