1
|
Lima FDS, Gonçalves CEDS, Fock RA. Zinc and aging: a narrative review of the effects on hematopoiesis and its link with diseases. Nutr Rev 2024; 82:1125-1137. [PMID: 37717139 DOI: 10.1093/nutrit/nuad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023] Open
Abstract
There has been a global increase in the older population in recent decades and, as age advances, complex metabolic and epigenetic changes occur in the organism, and these may trigger some health complications commonly found among this population. Additionally, several changes occur in older people that can reduce the dietary intake or the process of nutrient absorption. In this way, tissues with high nutrient requirements are more affected. Hematopoiesis is the process of formation, development, and maturation of blood cells and is a process with a high turnover. This high demand makes the integrity of the hematopoietic process susceptible to various factors that impair physiological function, such as aging and micronutrient bioavailability. Among these micronutrients, Zinc is considered an important micronutrient, playing diverse roles across various tissues and cell types. Some of the alterations in hematopoiesis that appear as a consequence of aging and due to insufficient micronutrient intake are well described in the literature; however, not much is known about how zinc deficiency contributes towards the development of diseases seen in aging. Considering the importance of zinc to act on several biological processes, this narrative review discusses several studies related to the physiological requirements, deficiency, or excess of zinc, including studies in experimental models and humans, and aimed to shed light on the relationship between zinc and the regulation of hematopoietic tissue, exploring possible links between this mineral with common disorders that appear during aging.
Collapse
Affiliation(s)
- Fabiana Da Silva Lima
- Department of Food and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Ricardo Ambrósio Fock
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Engelhardt M, Ihorst G, Duque-Afonso J, Wedding U, Spät-Schwalbe E, Goede V, Kolb G, Stauder R, Wäsch R. Structured assessment of frailty in multiple myeloma as a paradigm of individualized treatment algorithms in cancer patients at advanced age. Haematologica 2020; 105:1183-1188. [PMID: 32241848 PMCID: PMC7193478 DOI: 10.3324/haematol.2019.242958] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Monika Engelhardt
- Department of Medicine I, Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jesus Duque-Afonso
- Department of Medicine I, Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Ernst Spät-Schwalbe
- Vivantes Klinikum Spandau, Innere Medizin, Hämatologie, Onkologie, Palliativmedizin, Berlin, Germany
| | | | - Gerald Kolb
- Bonifatius Hospital Lingen, Medizinische Klinik, Fachbereich Geriatrie, Akademisches Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Münster, Germany
| | - Reinhard Stauder
- Universitätsklinik für Innere Medizin V (Hämatologie und Onkologie), Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Ralph Wäsch
- Department of Medicine I, Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
3
|
Boureau AS, de Decker L. Blood transfusion in older patients. Transfus Clin Biol 2019; 26:160-163. [DOI: 10.1016/j.tracli.2019.06.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
|
4
|
Buske C, Hutchings M, Ladetto M, Goede V, Mey U, Soubeyran P, Spina M, Stauder R, Trněný M, Wedding U, Fields P. ESMO Consensus Conference on malignant lymphoma: general perspectives and recommendations for the clinical management of the elderly patient with malignant lymphoma. Ann Oncol 2019; 29:544-562. [PMID: 29194473 DOI: 10.1093/annonc/mdx413] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on mature B cell lymphomas and chronic lymphocytic leukaemia (CLL) was held on 20 June 2015 in Lugano, Switzerland, and included a multidisciplinary panel of 25 leading experts. The aim of the conference was to develop recommendations on critical subjects difficult to consider in detail in the ESMO Clinical Practice Guidelines. The following areas were identified: (1) the elderly patient, (2) prognostic factors suitable for clinical use, and (3) the 'ultra-high-risk' group. Before the conference, the expert panel was divided into three working groups; each group focused on one of these areas in order to address clinically-relevant questions relating to that topic. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, each working group developed recommendations to address each of the four questions assigned to their group. These recommendations were presented to the entire panel and a consensus was reached. This consensus, which was further developed in continuous post-meeting discussions, formed the basis of three manuscripts, each covering one of the three key areas identified. This manuscript presents the consensus recommendations regarding the clinical management of elderly patients diagnosed with malignant lymphoma. Four clinically-relevant topics identified by the panel were: 1) how to define patient fitness, 2) assessing quality of life, 3) diagnostic work-up and 4) clinical management of elderly patients with lymphoma. Each of these key topics is addressed in the context of five different lymphoma entities, namely: CLL, follicular lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma and diffuse large B-cell lymphoma. Results, including a summary of evidence supporting each recommendation, are detailed in this manuscript.
Collapse
Affiliation(s)
- C Buske
- Comprehensive Cancer Center Ulm and Department of Internal Medicine III, Institute of Experimental Cancer Research, University Hospital, Ulm, Germany.
| | - M Hutchings
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - M Ladetto
- Hematology Division, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - V Goede
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - U Mey
- Department of Oncology and Haematology, Kantonsspital Graubünden, Chur, Switzerland
| | - P Soubeyran
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - M Spina
- Division of Medical Oncology A, National Cancer Institute, Aviano, Italy
| | - R Stauder
- Haematology and Oncology Department, Innsbruck Medical University, Innsbruck, Austria
| | - M Trněný
- Institute of Hematology and Blood Transfusion, Ist Department of Medicine, 1st Faculty of Medicine, Charles University General Hospital, Prague, Czech Republic
| | - U Wedding
- Department of Palliative Care, University Hospital, Jena, Germany
| | - P Fields
- Department of Haematology, Guys and St Thomas' and King's College Hospitals, London, UK
| | | |
Collapse
|
5
|
Kubasch AS, Platzbecker U. Beyond the Edge of Hypomethylating Agents: Novel Combination Strategies for Older Adults with Advanced MDS and AML. Cancers (Basel) 2018; 10:E158. [PMID: 29795051 PMCID: PMC6025349 DOI: 10.3390/cancers10060158] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/19/2018] [Accepted: 05/21/2018] [Indexed: 12/14/2022] Open
Abstract
Higher-risk myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) of the elderly exhibit several commonalities, including first line treatment with hypomethylating agents (HMA) like azacitidine (AZA) or decitabine (DAC). Until today, response to treatment occurs in less than 50 percent of patients, and is often short-lived. Moreover, patients failing HMA have a dismal prognosis. Current developments include combinations of HMA with novel drugs targeting epigenetic or immunomodulatory pathways. Other efforts focus on the prevention of resistance to HMA using checkpoint inhibitors to enhance immune attack. This review focuses on recent advances in the field of HMA-based front-line therapies in elderly patients with myeloid diseases.
Collapse
Affiliation(s)
- Anne Sophie Kubasch
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany.
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany.
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany.
- German Cancer Consortium (DKTK), 01307 Dresden, Germany.
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
| |
Collapse
|
6
|
Health-related quality of life in lower-risk MDS patients compared with age- and sex-matched reference populations: a European LeukemiaNet study. Leukemia 2018; 32:1380-1392. [PMID: 29572506 PMCID: PMC5990524 DOI: 10.1038/s41375-018-0089-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 01/05/2023]
Abstract
In myelodysplastic syndromes (MDS), health-related quality of life (HRQoL) represents a relevant patient-reported outcome, which is essential in individualized therapy planning. Prospective data on HRQoL in lower-risk MDS remain rare. We assessed HRQOL by EQ-5D questionnaire at initial diagnosis in 1690 consecutive IPSS-Low/Int-1 MDS patients from the European LeukemiaNet Registry. Impairments were compared with age- and sex-matched EuroQol Group norms. A significant proportion of MDS patients reported moderate/severe problems in the dimensions pain/discomfort (49.5%), mobility (41.0%), anxiety/depression (37.9%), and usual activities (36.1%). Limitations in mobility, self-care, usual activities, pain/discomfort, and EQ-VAS were significantly more frequent in the old, in females, and in those with high co-morbidity burden, low haemoglobin levels, or red blood cells transfusion need (p < 0.001). In comparison to age- and sex-matched peers, the proportion of problems in usual activities and anxiety/depression was significantly higher in MDS patients (p < 0.001). MDS-related restrictions in the dimension mobility were most prominent in males, and in older people (p < 0.001); in anxiety/depression in females and in younger people (p < 0.001); and in EQ-VAS in women and in persons older than 75 years (p < 0.05). Patients newly diagnosed with IPSS lower-risk MDS experience a pronounced reduction in HRQoL and a clustering of restrictions in distinct dimensions of HRQoL as compared with reference populations.
Collapse
|
7
|
Valent P, Stauder R, Theurl I, Geissler K, Sliwa T, Sperr WR, Bettelheim P, Sill H, Pfeilstöcker M. Diagnosis, management and response criteria of iron overload in myelodysplastic syndromes (MDS): updated recommendations of the Austrian MDS platform. Expert Rev Hematol 2018; 11:109-116. [PMID: 29292655 DOI: 10.1080/17474086.2018.1420473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Despite the availability of effective iron chelators, transfusion-related morbidity is still a challenge in chronically transfused patients with myelodysplastic syndromes (MDS). In these patients, transfusion-induced iron overload may lead to organ dysfunction or even organ failure. In addition, iron overload is associated with reduced overall survival in MDS. Areas covered: During the past 10 years, various guidelines for the management of MDS patients with iron overload have been proposed. In the present article, we provide our updated recommendations for the diagnosis, prevention and therapy of iron overload in MDS. In addition, we propose refined treatment response criteria. As in 2006 and 2007, recommendations were discussed and formulated by participants of our Austrian MDS platform in a series of meetings in 2016 and 2017. Expert commentary: Our updated recommendations should support early recognition of iron overload, optimal patient management and the measurement of clinical responses to chelation treatment in daily practice.
Collapse
Affiliation(s)
- Peter Valent
- a Department of Internal Medicine I, Division of Hematology & Hemostaseology , Medical University of Vienna , Vienna , Austria.,b Ludwig Boltzmann Cluster Oncology , Medical University of Vienna , Vienna , Austria
| | - Reinhard Stauder
- c Department of Internal Medicine V (Hematology and Oncology) , Medical University Innsbruck , Innsbruck , Austria
| | - Igor Theurl
- d Department of Internal Medicine II (Infectious Diseases, Immunology, Rheumatology, Pneumology) , Medical University Innsbruck , Innsbruck , Austria
| | - Klaus Geissler
- e Vth Medical Department with Hematology, Oncology and Palliative Medicine , Hospital Hietzing , Vienna , Austria
| | - Thamer Sliwa
- f 3rd Medical Department , Hanusch Hospital , Vienna , Austria
| | - Wolfgang R Sperr
- a Department of Internal Medicine I, Division of Hematology & Hemostaseology , Medical University of Vienna , Vienna , Austria.,b Ludwig Boltzmann Cluster Oncology , Medical University of Vienna , Vienna , Austria
| | - Peter Bettelheim
- g Department of Internal Medicine , Elisabethinen Hospital , Linz , Austria
| | - Heinz Sill
- h Division of Hematology, Department of Internal Medicine , Medical University of Graz , Graz , Austria
| | - Michael Pfeilstöcker
- b Ludwig Boltzmann Cluster Oncology , Medical University of Vienna , Vienna , Austria.,f 3rd Medical Department , Hanusch Hospital , Vienna , Austria
| |
Collapse
|
8
|
Röhrig G, Becker I, Pappas K, Polidori MC, Schulz RJ. Analysis of cytopenia in geriatric inpatients. Z Gerontol Geriatr 2017; 51:231-236. [PMID: 28660533 DOI: 10.1007/s00391-017-1280-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 06/09/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Peripheral blood dyscrasias in older patients are repeatedly seen in geriatric clinical practice; however, there is substantial lack of data about the epidemiology, possible causes and treatment options in this patient group. Proton pump inhibitors (PPI) are extensively used in older patients and associated with leukopenia. The primary objective of this study was the assessment of encoded cytopenia prevalence in a geriatric patient cohort and the secondary objective was the assessment of putative causes and the analysis of PPI administration in patients with cytopenia. METHODS Retrospective evaluation of patients admitted to the geriatric department of a German urban hospital between 2010 and 2012. Electronic patient data were screened for encoded diagnosis of cytopenia according to the International Classification of Diseases (ICD) 10. Inclusion criteria were ICD code D69.0-9 and/or D70.0-7, age ≥60 years and exclusion criteria were no ICD code D69.0-9 and/or D70.0-7 and age <60 years. Out of 9328 screened inpatients 54 patients remained for analysis. Study parameters included hemoglobin (Hb), red blood cell count (RBC), leucocytes, platelets, mean cell volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), presence of leukopenia (<4000/µl), presence of thrombocytopenia (<140,000/µl) and presence of anemia according to the World Health Organization (WHO). Substitution of blood products, medication with PPI and potential causes for dyscrasias were evaluated based on electronic patient records. RESULTS The mean age was 78.3 ± 6.5 years (27 females, 27 males), anemia was seen in 78%, leukopenia was encoded in13% and thrombocytopenia in 44.4%. In most of the patients no substitution of blood products was documented. In most of the patients (20.4%) cytopenia was attributed to either heparin-induced thrombocytopenia (HIT) or hemato-oncologic (20.4%) diseases, followed by drug association in 18.5%. In 70.8% of the study patients PPIs were administered but the indication for PPI administration remained unclear in 20.4%. CONCLUSION The results encourage accurate assessment of blood dyscrasias and appropriate documentation as well as indication check for PPI treatment in geriatric inpatients.
Collapse
Affiliation(s)
- G Röhrig
- Ageing Clinical Research, Department II Internal Medicine, University Hospital Cologne, Cologne, Germany. .,Geriatric Department, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany.
| | - I Becker
- Institute for Medical Statistics, Informatics and Epidemiology, University Hospital Cologne, Cologne, Germany
| | - K Pappas
- Ageing Clinical Research, Department II Internal Medicine, University Hospital Cologne, Cologne, Germany.,Geriatric Department, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany
| | - M C Polidori
- Ageing Clinical Research, Department II Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - R J Schulz
- Geriatric Department, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany
| |
Collapse
|
9
|
Hirsch CM, Przychodzen BP, Radivoyevitch T, Patel B, Thota S, Clemente MJ, Nagata Y, LaFramboise T, Carraway HE, Nazha A, Sekeres MA, Makishima H, Maciejewski JP. Molecular features of early onset adult myelodysplastic syndrome. Haematologica 2017; 102:1028-1034. [PMID: 28255022 PMCID: PMC5451334 DOI: 10.3324/haematol.2016.159772] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/28/2017] [Indexed: 02/06/2023] Open
Abstract
Myelodysplastic syndromes are typically diseases of older adults. Patients in whom the onset is early may have distinct molecular and clinical features or reflect a demographic continuum. The identification of differences between "early onset" patients and those diagnosed at a traditional age has the potential to advance understanding of the pathogenesis of myelodysplasia and may lead to formation of distinct morphological subcategories. We studied a cohort of 634 patients with various subcategories of myelodysplastic syndrome and secondary acute myeloid leukemia, stratifying them based on age at presentation and clinical parameters. We then characterized molecular abnormalities detected by next-generation deep sequencing of 60 genes that are commonly mutated in myeloid malignancies. The number of mutations increased linearly with age and on average, patients >50 years of age had more mutations. TET2, SRSF2, and DNMT3A were more commonly mutated in patients >50 years old compared to patients ≤50 years old. In general, patients >50 years of age also had more mutations in spliceosomal, epigenetic modifier, and RAS gene families. Although there are age-related differences in molecular features among patients with myelodysplasia, most notably in the incidence of SRSF2 mutations, our results suggest that patients ≤50 years old belong to a disease continuum with a distinct pattern of early onset ancestral events.
Collapse
Affiliation(s)
- Cassandra M Hirsch
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
- Department of Genetics and Genome Science, Case Western Reserve University, Cleveland, OH, USA
| | - Bartlomiej P Przychodzen
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Tomas Radivoyevitch
- Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, OH, USA
| | - Bhumika Patel
- Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Swapna Thota
- Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Michael J Clemente
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Yasunobu Nagata
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Thomas LaFramboise
- Department of Genetics and Genome Science, Case Western Reserve University, Cleveland, OH, USA
| | - Hetty E Carraway
- Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Aziz Nazha
- Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Mikkael A Sekeres
- Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Hideki Makishima
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Japan
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
- Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| |
Collapse
|
10
|
Allogeneic hematopoietic stem cell transplantation for MDS and CMML: recommendations from an international expert panel. Blood 2017; 129:1753-1762. [PMID: 28096091 DOI: 10.1182/blood-2016-06-724500] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 01/04/2017] [Indexed: 01/19/2023] Open
Abstract
An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.
Collapse
|
11
|
Takahashi N, Kameoka J, Takahashi N, Tamai Y, Murai K, Honma R, Noji H, Yokoyama H, Tomiya Y, Kato Y, Ishizawa K, Ito S, Ishida Y, Sawada K, Harigae H. Causes of macrocytic anemia among 628 patients: mean corpuscular volumes of 114 and 130 fL as critical markers for categorization. Int J Hematol 2016; 104:344-57. [PMID: 27352093 DOI: 10.1007/s12185-016-2043-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 12/13/2022]
Abstract
There have been no studies on the distribution of causes of macrocytic anemia with respect to mean corpuscular volume (MCV) cutoff values. We retrospectively investigated the causes of macrocytic anemia (MCV ≥100 fL) among 628 patients who visited the outpatient hematology clinic in Tohoku University Hospital. To ensure data validity, we also analyzed data from 307 patients in eight other hospitals in the Tohoku district. The leading causes of macrocytic anemia (number of patients, %) were myelodysplastic syndromes (121, 19.3 %), suspected bone marrow failure syndromes (BMF; 74, 11.8 %), aplastic anemia (51, 8.1 %), plasma cell dyscrasia (45, 7.2 %), and vitamin B12 deficiency (40, 6.4 %) in Tohoku University Hospital. We made three primary findings as follows. First, the most common cause of macrocytic anemia is BMF. Second, lymphoid and solid malignancies are also common causes of macrocytosis. Third, macrocytic anemia may be classified into three groups: Group 1 (megaloblastic anemia and medications), which can exceed MCV 130 fL; Group 2 (alcoholism/liver disease, BMF, myeloid malignancy, and hemolytic anemia), which can exceed MCV 114 fL; and Group 3 (lymphoid malignancy, chronic renal failure, hypothyroidism, and solid tumors), which does not exceed MCV 114 fL. These conclusions were supported by the results from eight other hospitals.
Collapse
Affiliation(s)
- Natsuko Takahashi
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan
| | - Junichi Kameoka
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshiko Tamai
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazunori Murai
- Department of Hematology/Oncology, Internal Medicine, Iwate Medical University, Morioka, Japan.,Department of Hematology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Riko Honma
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hideyoshi Noji
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | | | - Yasuo Tomiya
- Department of Hematology, Miyagi Cancer Center, Natori, Japan
| | - Yuichi Kato
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kenichi Ishizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Shigeki Ito
- Department of Hematology/Oncology, Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Yoji Ishida
- Department of Hematology/Oncology, Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Kenichi Sawada
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan
| |
Collapse
|