Polycythaemia and thrombocythaemia in the elderly.

Area of Science:

• Hematology
• Geriatric Medicine
• Oncology

Background:

• Elderly patients presenting with elevated packed cell volume (PCV) require careful investigation.
• Distinguishing between raised red cell mass (RCM) and apparent/relative polycythaemia is essential for accurate diagnosis.

Purpose of the Study:

• To outline the diagnostic approach for elderly patients with elevated PCV.
• To describe the characteristics and management of different types of polycythaemia and thrombocytosis in the elderly.

Main Methods:

• Clinical and laboratory investigations to assess red cell mass (RCM).
• Classification of polycythaemia into primary proliferative polycythaemia (PPP), secondary polycythaemia, and idiopathic erythrocytosis.
• Evaluation of patients with normal RCM but elevated PCV (apparent or relative polycythaemia).

Main Results:

• Primary proliferative polycythaemia (PPP) is a clonal disorder common in the elderly, often presenting with vascular occlusive events.
• Secondary polycythaemia is frequently linked to hypoxaemia or renal lesions.
• Idiopathic erythrocytosis, relative polycythaemia, and apparent polycythaemia require risk factor modification and sometimes venesection.

Conclusions:

• Accurate diagnosis of polycythaemia in the elderly is vital for appropriate management.
• Treatment strategies, including 32P, venesection, or busulphan for PPP, and risk factor control for other forms, aim to prevent vascular complications.
• Reactive thrombocytosis is common in the elderly, usually linked to malignancy or infection, while primary thrombocythaemia (PT) is a myeloproliferative disorder requiring specific management.