Be Blood Safe

Rare blood dis­or­ders can strike older adults. Here’s all you need to know about them…

Health & Nutrition - - CON­TENTS -

Dis­cover the undis­cov­ered blood dis­or­der Se­nior Care

As an older adult, you’re at higher risk of a group of blood dis­or­ders you may not have heard of – MDS(myelodys­plas­tic syn­dromes), a se­ries of dif­fer­ent dis­eases that af­fect the func­tion and num­bers of blood cells. Com­pli­ca­tions that can arise from MDS in­clude ane­mia, in­fec­tions and ex­cess bleed­ing. Oc­ca­sion­ally, MDS de­vel­ops into can­cer, and stud­ies sug­gest MDS pa­tients also are at higher risk than other se­niors for heart at­tack and di­a­betes. Shya­mala C Navada, MD, as­sis­tant pro­fes­sor of hema­tol­ogy/ on­col­ogy at Mount Si­nai Med­i­cal Cen­tre, US, con­firms that MDS is a health is­sue older adults need to be aware of if they have the risk fac­tors as­so­ci­ated with this type of blood dis­or­der. “It’s an im­por­tant health is­sue that will likely be­come a grow­ing prob­lem with the in­creas­ing life span of the gen­eral pop­u­la­tion,” Dr Navada says. How­ever, it is im­por­tant to re­mem­ber that many MDS pa­tients do well for a long time with sup­port­ive treat­ment.

STEM CELL PROB­LEM

MDS de­vel­ops due to a prob­lem with bone mar­row, the soft, fatty tis­sue found in the hol­low in­te­rior of cer­tain bones, in­clud­ing the hips, fe­mur, ster­num, skull, ribs, ver­te­brae and shoul­der blades. Bone mar­row pro­duces stem cells: Im­ma­ture cells that dif­fer­en­ti­ate (de­velop) into par­tic­u­lar kinds of cells, in­clud­ing the red blood cells that trans­port oxy­gen in the body, the white blood cells that fight in­fec­tion, and the platelets that as­sist with blood clot­ting. In MDS, these stem cells don’t ma­ture into healthy, dif­fer­en­ti­ated cells. “They may ac­cu­mu­late in the bone mar­row, or they may have a short­ened life span, re­sult­ing in a de­crease in ma­ture blood cells in the cir­cu­la­tion,” Dr Navada ex­plains. “In ad­di­tion, many of the ma­ture blood cells do not func­tion prop­erly.” Over time, the num­ber of im­ma­ture, de­fec­tive cells be­gin to ex­ceed the num­ber of healthy cells, even­tu­ally re­sult­ing in symp­toms such as ane­mia (marked by short­ness of breath, fa­tigue, and a pale com­plex­ion), in­creased sus­cep­ti­bil­ity to in­fec­tion, and easy bleed­ing and/ or bruis­ing. In some pa­tients, MDS can de­velop into acute myeloid leukemia (AML), a rapidly

MDS can lower your white blood cell count, putting you at risk for in­fec­tions. Re­duce this risk by wash­ing your hands fre­quently in hot, soapy wa­ter, es­pe­cially be­fore pre­par­ing and/ or eat­ing food.

pro­gress­ing type of can­cer that af­fects im­ma­ture blood cells.

RISK FAC­TORS IN­CLUDE CAN­CER TREAT­MENT

You are at higher risk of MDS if you have re­ceived prior chemo­ther­apy or ra­di­a­tion, both of which are used to treat other can­cers. Also im­pli­cated is ex­po­sure to to­bacco smoke, pes­ti­cides, in­dus­trial chem­i­cals (no­tably ben­zene, which is emit­ted by burn­ing coal and oil and also is present in mo­tor ve­hi­cle ex­haust, as well as used in the pro­duc­tion of plas­tics, de­ter­gents and pes­ti­cides), and heavy met­als, in­clud­ing lead and mer­cury.

NEW TREAT­MENT HAV­ING AN IM­PACT

Treat­ment for MDS de­pends on your symp­toms, age, dis­ease stage, dis­ease risk cat­e­gory, and any pre­ex­ist­ing con­di­tions. The stan­dard ap­proach is sup­port­ive, treat­ing the signs and symp­toms of the dis­ease. “Treat­ments for low-risk MDS in­clude blood trans­fu­sions and growth fac­tors, in­clud­ing ery­thro­poi­etin, which de­creases the need for trans­fu­sion in ap­prox­i­mately 20% of MDS pa­tients,” Dr Navada ex­plains. “In pa­tients who are at in­ter­me­di­ate or high risk for com­pli­ca­tions, low­in­ten­sity chemo­ther­apy with med­i­ca­tion can im­prove blood counts, de­crease trans­fu­sion re­quire­ments, re­duce the risk for AML, and im­prove qual­ity of life. These newer drugs have had an im­pact, and cur­rent re­search is look­ing at com­bi­na­tion strate­gies to aug­ment re­sponse rates.”

STEM CELL TRANS­PLANTS AN OP­TION

Stem cell trans­plants also are an op­tion for treat­ing MDS, though the pro­ce­dure is risky for older adults. “Pa­tients of­ten have co­mor­bidi­ties that pre­clude them from be­ing a trans­plant can­di­date,” says Dr Navada. Stan­dard stem cell trans­plants also re­quire that ex­ist­ing bone mar­row be de­stroyed, typ­i­cally via chemo­ther­apy and ra­di­a­tion, and side ef­fects can be se­vere. A less in­tense op­tion is a mini-stem cell trans­plant. “This pro­ce­dure in­volves less in­ten­sive chemo­ther­apy, and is safer in older pa­tients,” Dr Navada ex­plains. “How­ever, there is an in­creased risk of re­lapse com­pared with nor­mal in­ten­sity reg­i­mens.”

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