Quaglino D, Ginaldi L, Furia N, De Martinis M
Department of Internal Medicine, University of L'Aquila, Italy.
Aging (Milano). 1996 Feb;8(1):1-12. doi: 10.1007/BF03340109.
Although several workers have described numerous changes affecting the hemopoietic system during senescence, the existence of univocal "hematological disease" closely related to the elderly is controversial. Many of the hematological changes described, such as sideropenic or megaloblastic anemia, are frequently the consequence of the different pathological conditions which often affect elderly patients. This review will consider the most important alterations of hemopoiesis and coagulation in the elderly, the causes capable of influencing hematological changes in old people, and their pathogenesis. Some of the major diagnostic problems encountered in the management of elderly subjects with hematological changes are also addressed. In the presence of an elderly patient with hematological alteration, it is necessary to follow a precise diagnostic schedule, which should first of all exclude the presence of a primary hematological disorder, and consider the different extrahematological conditions which frequently occur in elderly subjects (malignancies, malnutrition, chronic infections from immunological abnormalities, hormonal changes, deficiencies of various organs and systems etc.) and are responsible for many different hematological changes. These must be tackled rationally so that treatment may not only be symptomatic, but may also directly intervene on the cause of the disorder.
尽管有几位研究者描述了衰老过程中影响造血系统的众多变化，但与老年人密切相关的明确“血液疾病”的存在仍存在争议。所描述的许多血液学变化，如缺铁性或巨幼细胞贫血，往往是经常影响老年患者的不同病理状况的结果。本综述将探讨老年人造血和凝血的最重要改变、能够影响老年人血液学变化的原因及其发病机制。还讨论了在管理有血液学变化的老年患者时遇到的一些主要诊断问题。对于有血液学改变的老年患者，有必要遵循精确的诊断流程，首先应排除原发性血液系统疾病的存在，并考虑老年患者中经常出现的不同血液外情况（恶性肿瘤、营养不良、免疫异常引起的慢性感染、激素变化、各种器官和系统的功能缺陷等），这些情况是许多不同血液学变化的原因。必须合理应对这些情况，以便治疗不仅可以对症，还可以直接干预疾病的病因。
