Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Zeitschrift für Gerontologie und Geriatrie 2/2018

28.06.2017 | Original contribution

Analysis of cytopenia in geriatric inpatients

verfasst von: MPH Dr. med. G. Röhrig, I. Becker, K. Pappas, M. C. Polidori, R. J. Schulz

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
2.
Zurück zum Zitat Bach V, Schruckmayer G, Sam I, Kemmler G, Stauder R (2014) Prevalence and possible causes of anemia in the elderly: A cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging 9:1187–1196. doi: 10.​2147/​CIA.​S61125 PubMedPubMedCentral Bach V, Schruckmayer G, Sam I, Kemmler G, Stauder R (2014) Prevalence and possible causes of anemia in the elderly: A cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging 9:1187–1196. doi: 10.​2147/​CIA.​S61125 PubMedPubMedCentral
3.
Zurück zum Zitat Beloosesky Y, Cohen AM, Grosman B, Grinblat J (2000) Prevalence and survival of myelodysplastic syndrome of the refractory anemia type in hospitalized cognitively different geriatric patients. Gerontology 46(6):323–327 CrossRefPubMed Beloosesky Y, Cohen AM, Grosman B, Grinblat J (2000) Prevalence and survival of myelodysplastic syndrome of the refractory anemia type in hospitalized cognitively different geriatric patients. Gerontology 46(6):323–327 CrossRefPubMed
4.
6.
Zurück zum Zitat Chang CM, Lee NY, Lee HC, Lee IW, Wu CJ, Lin YS, Ko WC (2008) Moxifloxacin-associated neutropenia in a cirrhotic elderly woman with lower extremity cellulitis. Ann Pharmacother 42(4):580–583. doi: 10.​1345/​aph.​1K596 CrossRefPubMed Chang CM, Lee NY, Lee HC, Lee IW, Wu CJ, Lin YS, Ko WC (2008) Moxifloxacin-associated neutropenia in a cirrhotic elderly woman with lower extremity cellulitis. Ann Pharmacother 42(4):580–583. doi: 10.​1345/​aph.​1K596 CrossRefPubMed
8.
Zurück zum Zitat Chao CT, Tsai HB, Chiang CK, Huang JW (2017) COGENT (COhort of GEriatric Nephrology in NTUH) study group. Thrombocytopenia on the first day of emergency department visit predicts higher risk of acute kidney injury among elderly patients. Scand J Trauma Resusc Emerg Med 25(1):11. doi: 10.​1186/​s13049-017-0355-3 CrossRefPubMedPubMedCentral Chao CT, Tsai HB, Chiang CK, Huang JW (2017) COGENT (COhort of GEriatric Nephrology in NTUH) study group. Thrombocytopenia on the first day of emergency department visit predicts higher risk of acute kidney injury among elderly patients. Scand J Trauma Resusc Emerg Med 25(1):11. doi: 10.​1186/​s13049-017-0355-3 CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Iannini PB (2007) The safety profile of moxifloxacin and other fluoroquinolones in special patient populations. Curr Med Res Opin 23(6):1403–1413 CrossRefPubMed Iannini PB (2007) The safety profile of moxifloxacin and other fluoroquinolones in special patient populations. Curr Med Res Opin 23(6):1403–1413 CrossRefPubMed
14.
Zurück zum Zitat Repetto L, Biganzoli L, Koehne CH, Luebbe AS, Soubeyran P, Tjan-Heijnen VC, Aapro MS (2003) EORTC cancer in the elderly task force guidelines for the use of colony-stimulating factors in elderly patients with cancer. Eur J Cancer 39(16):2264–2272 CrossRefPubMed Repetto L, Biganzoli L, Koehne CH, Luebbe AS, Soubeyran P, Tjan-Heijnen VC, Aapro MS (2003) EORTC cancer in the elderly task force guidelines for the use of colony-stimulating factors in elderly patients with cancer. Eur J Cancer 39(16):2264–2272 CrossRefPubMed
15.
Zurück zum Zitat Rodríguez-Mañas L, Gómez-Huelgas R, Veiga-Fernández F, Ruiz GM, González JM, ANCIANOS Investigators (2010) Thromboprophylaxis with the low-molecular-weight heparin bemiparin sodium in elderly medical patients in usual clinical practice: the ANCIANOS study. Clin Drug Investig 30(5):337–345. doi: 10.​2165/​11535460-000000000-00000 CrossRefPubMed Rodríguez-Mañas L, Gómez-Huelgas R, Veiga-Fernández F, Ruiz GM, González JM, ANCIANOS Investigators (2010) Thromboprophylaxis with the low-molecular-weight heparin bemiparin sodium in elderly medical patients in usual clinical practice: the ANCIANOS study. Clin Drug Investig 30(5):337–345. doi: 10.​2165/​11535460-000000000-00000 CrossRefPubMed
16.
Zurück zum Zitat Röhrig G, Becker I, Schulz RJ, Lenzen-Großimlinghaus R, Willschrei P, Gebauer S, Modreker M, Jäger M, Wirth R (2016) Association between hematologic parameters and functional impairment among geriatric inpatients: Data of a prospective cross-sectional multicenter study (“GeriPrävalenz2013”). Maturitas 90:37–41. doi: 10.​1016/​j.​maturitas.​2016.​04.​020 CrossRefPubMed Röhrig G, Becker I, Schulz RJ, Lenzen-Großimlinghaus R, Willschrei P, Gebauer S, Modreker M, Jäger M, Wirth R (2016) Association between hematologic parameters and functional impairment among geriatric inpatients: Data of a prospective cross-sectional multicenter study (“GeriPrävalenz2013”). Maturitas 90:37–41. doi: 10.​1016/​j.​maturitas.​2016.​04.​020 CrossRefPubMed
17.
Zurück zum Zitat Röhrig G, Hörter M, Becker I, Adams A, Gebauer S, Jäger M, Lenzen-Grossimlinghaus R, Modreker MK, Schulz RJ, Willschrei HP, Wirth R (2016) Anemia and hematologic parameters in older patients: Results of a German multicentric cross-sectional study. Eur Geriatr Med 7(4):328–332 CrossRef Röhrig G, Hörter M, Becker I, Adams A, Gebauer S, Jäger M, Lenzen-Grossimlinghaus R, Modreker MK, Schulz RJ, Willschrei HP, Wirth R (2016) Anemia and hematologic parameters in older patients: Results of a German multicentric cross-sectional study. Eur Geriatr Med 7(4):328–332 CrossRef
18.
Zurück zum Zitat Sherigar JM, Gayam V, Khan A, Mukhtar O, Arefiev Y, Khalid M, Siddiqui I, Rangaraju AM, Budhathoki N, Mansour M, Guss D, Mohanty SR (2017) Clinical efficacy and tolerability of direct-acting antivirals in elderly patients with chronic hepatitis C. Eur J Gastroenterol Hepatol. doi: 10.​1097/​MEG.​0000000000000871​ PubMedPubMedCentral Sherigar JM, Gayam V, Khan A, Mukhtar O, Arefiev Y, Khalid M, Siddiqui I, Rangaraju AM, Budhathoki N, Mansour M, Guss D, Mohanty SR (2017) Clinical efficacy and tolerability of direct-acting antivirals in elderly patients with chronic hepatitis C. Eur J Gastroenterol Hepatol. doi: 10.​1097/​MEG.​0000000000000871​ PubMedPubMedCentral
19.
Zurück zum Zitat Triscott JA, Dobbs BM, McKay RM, Babenko O, Triscott E (2015) Prevalence and types of anemia and associations with functional decline in geriatric inpatients. J Frailty Aging 4(1):7–12. doi: 10.​14283/​jfa.​2015.​35 PubMed Triscott JA, Dobbs BM, McKay RM, Babenko O, Triscott E (2015) Prevalence and types of anemia and associations with functional decline in geriatric inpatients. J Frailty Aging 4(1):7–12. doi: 10.​14283/​jfa.​2015.​35 PubMed
20.
Zurück zum Zitat Wallerstedt SM, Fastbom J, Linke J, Vitols S (2017) Long-term use of proton pump inhibitors and prevalence of disease- and drug-related reasons for gastroprotection – a cross-sectional population-based study. Pharmacoepidemiol Drug Saf 26(1):9–16. doi: 10.​1002/​pds.​4135 CrossRefPubMed Wallerstedt SM, Fastbom J, Linke J, Vitols S (2017) Long-term use of proton pump inhibitors and prevalence of disease- and drug-related reasons for gastroprotection – a cross-sectional population-based study. Pharmacoepidemiol Drug Saf 26(1):9–16. doi: 10.​1002/​pds.​4135 CrossRefPubMed
22.
Zurück zum Zitat Zhou K, Wen F, Zhang P, Zhou J, Chen H, Zheng H, Yang Y, Li Q (2017) Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer. Clin Transl Oncol. doi: 10.​1007/​s12094-017-1647-9 Zhou K, Wen F, Zhang P, Zhou J, Chen H, Zheng H, Yang Y, Li Q (2017) Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer. Clin Transl Oncol. doi: 10.​1007/​s12094-017-1647-9
23.
Zurück zum Zitat Zilinski J, Zillmann R, Becker I, Benzing T, Schulz RJ, Röhrig G (2014) Prevalence of anemia among elderly inpatients and its association with multidimensional loss of function. Ann Hematol 93(10):1645–1654 CrossRefPubMed Zilinski J, Zillmann R, Becker I, Benzing T, Schulz RJ, Röhrig G (2014) Prevalence of anemia among elderly inpatients and its association with multidimensional loss of function. Ann Hematol 93(10):1645–1654 CrossRefPubMed
Metadaten
Titel
Analysis of cytopenia in geriatric inpatients
verfasst von
MPH Dr. med. G. Röhrig
I. Becker
K. Pappas
M. C. Polidori
R. J. Schulz
Publikationsdatum
28.06.2017
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 2/2018
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-017-1280-9

Weitere Artikel der Ausgabe 2/2018

Zeitschrift für Gerontologie und Geriatrie 2/2018 Zur Ausgabe

Themenschwerpunkt

Soft Skills

Journal Club

Journal Club

Mitteilungen der DGGG

Mitteilungen der DGGG

Mitteilungen der DGG

Mitteilungen der DGG