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Bleeding and coagulation disorders in the elderly.

J A Copplestone

    Bailliere'S Clinical Haematology
    |June 1, 1987
    PubMed
    Summary
    This summary is machine-generated.

    Elderly individuals experience more severe bleeding due to disease burden, not coagulation changes. Diagnosis involves history, exams, and simple tests, with treatments tailored to the cause.

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    Area of Science:

    • Geriatrics
    • Hematology
    • Internal Medicine

    Background:

    • Aging does not significantly alter coagulation, fibrinolysis, or platelet proteins.
    • Elderly patients have reduced physiological reserves, exacerbating hemorrhage consequences.
    • Increased disease burden in the elderly heightens risks associated with bleeding events.

    Purpose of the Study:

    • To outline diagnostic approaches for bleeding diathesis in the elderly.
    • To review current and emerging treatment strategies for bleeding disorders in older adults.
    • To highlight drug-induced bleeding, particularly anticoagulants, as a significant concern.

    Main Methods:

    • Clinical history and physical examination.
    • Standard laboratory tests: platelet count, blood film, bleeding time, prothrombin time, partial thromboplastin time, thrombin time, fibrin degradation products, euglobulin clot lysis time.

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  • Confirmatory assays, inhibitor titres, and specialized tests.

    • Main Results:

    • Diagnosis of bleeding diathesis is achievable through a systematic approach.
    • Effective treatments include addressing the underlying cause, platelet transfusion, fresh frozen plasma, or factor concentrates.
    • Management of inhibitors/antibodies may require steroids, splenectomy, plasma exchange, or immunosuppression.

    Conclusions:

    • High-dose intravenous immunoglobulin and DDAVP represent significant therapeutic advances.
    • Drug-induced bleeding, especially from anticoagulants and polypharmacy, is a critical concern in the elderly.
    • Prompt diagnosis and tailored treatment are essential for managing bleeding disorders in aging populations.