{"id":715,"date":"2025-08-09T14:12:18","date_gmt":"2025-08-09T11:12:18","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=715"},"modified":"2025-08-09T14:12:58","modified_gmt":"2025-08-09T11:12:58","slug":"yaslilarda-hematolojik-sorunlar-tani-ve-tedavisi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-hematolojik-sorunlar-tani-ve-tedavisi\/","title":{"rendered":"Ya\u015fl\u0131larda Hematolojik Sorunlar, Tan\u0131 Ve Tedavisi"},"content":{"rendered":"\n<p><strong>Yazar:\u00a0<\/strong>Do\u00e7.Dr.Mehmet Altunta\u015f <strong>Edit\u00f6r: <\/strong>Prof.Dr. \u00d6zlem K\u00f6ksal<\/p>\n\n\n\n<p>D\u00fcnya ya\u015flan\u0131yor ve bu durum sa\u011fl\u0131k alan\u0131nda yeni zorluklarla kar\u015f\u0131m\u0131za \u00e7\u0131k\u0131yor. \u00d6zellikle hematolojik hastal\u0131klar konusunda bu de\u011fi\u015fimi net bir \u015fekilde g\u00f6r\u00fcyoruz. Avrupa&#8217;da 80 ya\u015f \u00fcst\u00fc n\u00fcfusun 2060 y\u0131l\u0131na kadar \u00fc\u00e7 kat\u0131na \u00e7\u0131kaca\u011f\u0131 \u00f6ng\u00f6r\u00fcl\u00fcyor (1) &#8211; bu ger\u00e7ekten b\u00fcy\u00fck bir de\u011fi\u015fim!<\/p>\n\n\n\n<p>Bug\u00fcn hematolojik kanserlerinin %60&#8217;\u0131 65 ya\u015f \u00fcst\u00fc hastalarda g\u00f6r\u00fcl\u00fcyor ve bu oran artmaya devam edecek. Lenfoma, l\u00f6semi ve myelom hastalar\u0131n\u0131n ortalama ya\u015f\u0131 67-69 aras\u0131ndad\u0131r (2). Yani art\u0131k acil servislerde ya\u015fl\u0131 kan hastalar\u0131n\u0131 \u00e7ok daha s\u0131k g\u00f6rmeye ba\u015flad\u0131k.<\/p>\n\n\n\n<p>Bu yaz\u0131da, ya\u015fl\u0131 eri\u015fkinlerde hematolojik bozukluklar\u0131n tan\u0131 ve y\u00f6netimine dair g\u00fcncel yakla\u015f\u0131mlar\u0131, geriatrik de\u011ferlendirmenin \u00f6nemini ve acil t\u0131p bak\u0131\u015f a\u00e7\u0131s\u0131yla pratik \u00f6nerileri ele alaca\u011f\u0131z.<\/p>\n\n\n\n<p><strong>Ya\u015flanman\u0131n Hematolojik Sistem \u00dczerindeki Fizyolojik Etkileri<\/strong><\/p>\n\n\n\n<p>Ya\u015flanma ile birlikte hematopoetik sistemde \u00f6nemli de\u011fi\u015fiklikler g\u00f6r\u00fcl\u00fcr. Bu s\u00fcre\u00e7te hematopoetik k\u00f6k h\u00fccre DNA hasar\u0131, telomer k\u0131salmas\u0131, oksidatif stres ve kemik ili\u011fine yerle\u015fme yetene\u011finde azalma gibi sorunlarla kar\u015f\u0131la\u015f\u0131r (1).<strong><\/strong><\/p>\n\n\n\n<p><strong>Temel Fizyolojik De\u011fi\u015fiklikler:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Kemik ili\u011fi rezervinde azalma<\/li>\n\n\n\n<li>Lenfoid h\u00fccre \u00fcretiminin d\u00fc\u015fmesi<\/li>\n\n\n\n<li>Myeloid h\u00fccre serisinin bask\u0131nl\u0131\u011f\u0131<\/li>\n\n\n\n<li>Anemiye tolerans\u0131n azalmas\u0131<\/li>\n\n\n\n<li>Ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin ya\u015flanmas\u0131<\/li>\n<\/ul>\n\n\n\n<p>Bu genetik ve epigenetik hasarlar, medyan ya\u015f\u0131 65 ya\u015f \u00fczerinde olan bir pop\u00fclasyonda malign hematolojik hastal\u0131klara yol a\u00e7maktad\u0131r (2).<\/p>\n\n\n\n<p>Bu de\u011fi\u015fiklikler, hematolojik hastal\u0131klar\u0131n ya\u015fl\u0131 hastalarda atipik ve silik bulgularla seyretmesine neden olur (3). Bu nedenle yorgunluk, halsizlik, mental durgunluk gibi genel belirtiler dikkatle de\u011ferlendirilmelidir.<\/p>\n\n\n\n<p><strong>Ya\u015fl\u0131larda En S\u0131k Kar\u015f\u0131la\u015f\u0131lan Hematolojik Hastal\u0131klar<\/strong><\/p>\n\n\n\n<p><strong>Anemi<\/strong><\/p>\n\n\n\n<p>Anemi tan\u0131s\u0131 2005 y\u0131l\u0131nda 3 milyon ya\u015fl\u0131 ki\u015fide konulmu\u015f olup, 2030 y\u0131l\u0131nda ya\u015fl\u0131 n\u00fcfusun iki kat\u0131na \u00e7\u0131kmas\u0131yla bu say\u0131n\u0131n 6 milyon olaca\u011f\u0131 tahmin edilmektedir (4). Ya\u015fl\u0131larda anemi asla ya\u015fl\u0131l\u0131\u011fa ba\u011flanmamal\u0131d\u0131r (3). Hafif bir anemi bile, \u00e7oklu fiziksel ve mental problemlerle birle\u015fti\u011finde, daha \u00f6nce engellerini y\u00f6netebilen hastalar i\u00e7in dengeyi bozabilir (3).<strong><\/strong><\/p>\n\n\n\n<p><strong>Ba\u015fl\u0131ca Nedenleri:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Demir eksikli\u011fi (gastrointestinal kanamalar!)<\/li>\n\n\n\n<li>Kronik hastal\u0131k anemisi<\/li>\n\n\n\n<li>Vitamin B12 veya folat eksikli\u011fi<\/li>\n\n\n\n<li>Myelodisplastik sendromlar (MDS)<\/li>\n\n\n\n<li>A\u00e7\u0131klanamayan anemiler (yakla\u015f\u0131k %34) (4)<\/li>\n<\/ul>\n\n\n\n<p><strong>Acil yakla\u015f\u0131m:<\/strong>&nbsp;Dispne, ta\u015fikardi, senkop, bilin\u00e7 de\u011fi\u015fikli\u011fi gibi bulgular varsa hemogram, retik\u00fclosit, ferritin, B12, LDH ve periferik yayma de\u011ferlendirmesi yap\u0131lmal\u0131d\u0131r. Transf\u00fczyon karar\u0131 semptomlara ve hemoglobin d\u00fczeyine g\u00f6re verilir (genelde Hb &lt;7-8 g\/dL ise).<\/p>\n\n\n\n<p><strong>Trombositopeni<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda s\u0131k g\u00f6r\u00fclen nedenler:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u0130la\u00e7lar (\u00f6zellikle heparin, trimetoprim-s\u00fclfametoksazol, klopidogrel)<\/li>\n\n\n\n<li>\u0130mm\u00fcn trombositopenik purpura (ITP)<\/li>\n\n\n\n<li>MDS veya l\u00f6semi<\/li>\n<\/ul>\n\n\n\n<p><strong>Acil yakla\u015f\u0131m:<\/strong>&nbsp;Pete\u015fi, purpura, spontan kanamalar, kafa travmas\u0131 sonras\u0131 intrakraniyal kanama riski dikkate al\u0131nmal\u0131d\u0131r. Kanama e\u015flik ediyorsa hastaneye yat\u0131r\u0131lmal\u0131, trombosit seviyesine g\u00f6re transf\u00fczyon d\u00fc\u015f\u00fcn\u00fclmelidir (genelde &lt;10.000\/mm\u00b3 ise mutlak endikasyon).<\/p>\n\n\n\n<p><strong>L\u00f6kositoz veya L\u00f6kopeni<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Enfeksiyonlara ba\u011fl\u0131 olabilece\u011fi gibi, hematolojik malignitelerin de ilk bulgusu olabilir<\/li>\n\n\n\n<li>Ya\u015fl\u0131larda sepsis, n\u00f6tropeniyle ba\u015flayabilir!<\/li>\n<\/ul>\n\n\n\n<p><strong>Acil yakla\u015f\u0131m:<\/strong>&nbsp;Ate\u015fsiz enfeksiyon varl\u0131\u011f\u0131 d\u0131\u015flanmal\u0131d\u0131r. Yayma mutlaka de\u011ferlendirilmelidir. L\u00f6kositozda blast varl\u0131\u011f\u0131 akut l\u00f6semi a\u00e7\u0131s\u0131ndan \u00f6nemlidir.<\/p>\n\n\n\n<p><strong>Ya\u015fl\u0131larda Hematolojik Maligniteler: G\u00fcncel Veriler<\/strong><\/p>\n\n\n\n<p><strong>Akut Myeloblastik L\u00f6semi (AML)<\/strong><\/p>\n\n\n\n<p>2005 y\u0131l\u0131nda yakla\u015f\u0131k 12.000 ki\u015fiye AML tan\u0131s\u0131 konulmu\u015f olup, bu say\u0131 on y\u0131l \u00f6ncesine g\u00f6re %30&#8217;dan fazla art\u0131\u015f g\u00f6stermi\u015ftir. Bu art\u0131\u015f, \u00f6zellikle 80 ya\u015f \u00fcst\u00fc pop\u00fclasyondaki b\u00fcy\u00fcmeye ba\u011flanabilir (4).<\/p>\n\n\n\n<p><strong>G\u00fcncel tedavi yakla\u015f\u0131mlar\u0131:<\/strong>&nbsp;2024 y\u0131l\u0131nda yay\u0131nlanan bir \u00e7al\u0131\u015fmada, 80 ya\u015f \u00fcst\u00fc hastalarda standart bak\u0131m olan VEN-HMA (venetoclax ve hipometilasyon ajan\u0131) rejiminin g\u00fcvenli ve etkili oldu\u011fu, hastalar\u0131n yakla\u015f\u0131k %25&#8217;inde sa\u011fkal\u0131m\u0131 uzatabilece\u011fi g\u00f6sterilmi\u015ftir (5).<\/p>\n\n\n\n<p><strong>Myelodisplastik Sendromlar (MDS)<\/strong><\/p>\n\n\n\n<p>2030 y\u0131l\u0131na kadar 60 ya\u015f \u00fcst\u00fc hastalarda y\u0131lda 25.000-40.000 AML ve MDS vakas\u0131 g\u00f6r\u00fclece\u011fi tahmin edilmektedir (6).<\/p>\n\n\n\n<p><strong>Multipl Myelom<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda myelom insidans\u0131 artmakta olup, bu hastalarda geriatrik bozukluklar hakk\u0131nda \u00e7ok az bilgi bulunmaktad\u0131r.<\/p>\n\n\n\n<p><strong>Non-Hodgkin Lenfoma<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda epcoritamab-bysp, antrasiklinin kontrendike oldu\u011fu b\u00fcy\u00fck B h\u00fccreli lenfoma hastalar\u0131nda %69 objektif yan\u0131t oran\u0131 ve %62 tam yan\u0131t oran\u0131 g\u00f6stermi\u015ftir.<\/p>\n\n\n\n<p><strong>Geriatrik De\u011ferlendirmenin \u00d6nemi<\/strong><\/p>\n\n\n\n<p><strong>Kapsaml\u0131 Geriatrik De\u011ferlendirme (KGD)<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 yeti\u015fkinler hematolojik bozukluk tan\u0131s\u0131 konan hastalar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funu olu\u015fturmas\u0131na ra\u011fmen, klinik \u00e7al\u0131\u015fmalarda yeteri kadar temsil edilmemektedirler (7). Geriatrik de\u011ferlendirme, iyi performans durumuna sahip hastalarda bile geriatrik bozukluklar\u0131 tespit edebilir ve bu bozukluklar mortalite a\u00e7\u0131s\u0131ndan tahmin edici olabilir (8).<\/p>\n\n\n\n<p><strong>KGD&#8217;nin Temel Bile\u015fenleri:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fonksiyonel durum de\u011ferlendirmesi<\/li>\n\n\n\n<li>Komorbiditeler<\/li>\n\n\n\n<li>Polifarmasi<\/li>\n\n\n\n<li>Beslenme durumu<\/li>\n\n\n\n<li>Kognitif de\u011ferlendirme<\/li>\n\n\n\n<li>Sosyal destek<\/li>\n<\/ul>\n\n\n\n<p><strong>\u00d6zel Tarama Ara\u00e7lar\u0131<\/strong><\/p>\n\n\n\n<p><strong>GAH (Geriatrik Assessment in Hematology) \u00d6l\u00e7e\u011fi:&nbsp;<\/strong>GAH \u00f6l\u00e7e\u011fi, \u0130spanyol hematoloji uzmanlar\u0131 ve geriatri uzmanlar\u0131 taraf\u0131ndan geli\u015ftirilen, 10-15 dakikada tamamlanabilen ve \u00e7e\u015fitli hematolojik malignitelere sahip ya\u015fl\u0131 hastalar\u0131 tan\u0131mlayabilen k\u0131sa bir geriatrik de\u011ferlendirme arac\u0131d\u0131r (9).<\/p>\n\n\n\n<p><strong>G8 Tarama Arac\u0131:&nbsp;<\/strong>G8 skorlamas\u0131 ya\u015f ve &#8220;Mini Nutritional Assessment&#8221;ten t\u00fcretilen 7 soruyu i\u00e7erir. G8 ve CGA&#8217;y\u0131 kar\u015f\u0131la\u015ft\u0131ran \u00e7al\u0131\u015fmalarda sensitivite %65-92 aras\u0131nda, spesifisite %30-75 aras\u0131nda de\u011fi\u015fmektedir (10).<\/p>\n\n\n\n<p><strong>Timed Up and Go (TUG) Testi:&nbsp;<\/strong>G\u00fcncel ASH 2024 verilerine g\u00f6re, anormal TUG s\u00fcreleri hem hematolojik hem de non-hematolojik toksisitelerle korelasyon g\u00f6stermekte, ayr\u0131ca daha d\u00fc\u015f\u00fck progresyonsuz sa\u011fkal\u0131m ve genel sa\u011fkal\u0131m oranlar\u0131yla ili\u015fkili bulunmu\u015ftur (6).<\/p>\n\n\n\n<p><strong>Geriatrik De\u011ferlendirmenin Klinik Sonu\u00e7lara Etkisi<\/strong><\/p>\n\n\n\n<p>Geriatrik bozukluklar\u0131n medyan prevalans\u0131, iyi WHO performans durumuna sahip hastalarda bile %17-68 aras\u0131nda de\u011fi\u015fmektedir. Polifarmasi, beslenme durumu ve enstr\u00fcmantal g\u00fcnl\u00fck ya\u015fam aktiviteleri en s\u0131k bozulan alanlard\u0131r. Geriatrik bozukluklar ve k\u0131r\u0131lganl\u0131k daha k\u0131sa genel sa\u011fkal\u0131mla ili\u015fkili bulunurken, WHO performans durumu \u00e7o\u011fu \u00e7al\u0131\u015fmada prediktif de\u011ferini kaybetmi\u015ftir (7).<\/p>\n\n\n\n<p><strong>Antikoag\u00fclan Kullan\u0131m\u0131 ve \u00d6zel Durumlar<\/strong><\/p>\n\n\n\n<p><strong>Ya\u015fl\u0131larda Antikoag\u00fclasyon Riskleri<\/strong><\/p>\n\n\n\n<p>65 ya\u015f ve \u00fczeri hastalar atriyal fibrilasyon (AF) ve ven\u00f6z tromboembolizm (VTE) hastalar\u0131n\u0131n \u00e7o\u011funlu\u011funu olu\u015fturmakla kalmay\u0131p, ayn\u0131 zamanda gen\u00e7 hastalara g\u00f6re daha y\u00fcksek morbidite, mortalite ve yetersiz tedavi riski alt\u0131ndad\u0131rlar (11). VTE&#8217;li hastalar\u0131n yakla\u015f\u0131k \u00fc\u00e7te ikisi ve AF&#8217;li hastalar\u0131n d\u00f6rtte biri bir y\u0131l i\u00e7inde \u00f6lecektir (12).<\/p>\n\n\n\n<p><strong>G\u00fcncel Antikoag\u00fclasyon Stratejileri<\/strong><\/p>\n\n\n\n<p><strong>Yeni Nesil Oral Antikoag\u00fclanlar (YOAK) ve Warfarin<\/strong><\/p>\n\n\n\n<p>S\u0131n\u0131rl\u0131 kan\u0131tlar YOAK&#8217;lar\u0131n ya\u015fl\u0131 hastalarda vitamin K antagonistlerine g\u00f6re daha etkili ve g\u00fcvenli olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir (12).<\/p>\n\n\n\n<p><strong>ELDERCARE-AF \u00c7al\u0131\u015fmas\u0131 Sonu\u00e7lar\u0131<\/strong><\/p>\n\n\n\n<p>80 ya\u015f \u00fcst\u00fc Japon hastalarda d\u00fc\u015f\u00fck doz antikoag\u00fclasyon plaseboya g\u00f6re daha fazla inmeyi \u00f6nlemi\u015f (HR 0.34) ancak sa\u011fkal\u0131m\u0131 etkilememi\u015ftir (HR 0.97). D\u00fc\u015f\u00fck doz DOAC maj\u00f6r kanama riskini art\u0131rmasa da gastrointestinal kanama riskini art\u0131rm\u0131\u015ft\u0131r (11).<\/p>\n\n\n\n<p><strong>Acil serviste yakla\u015f\u0131m:<\/strong>&nbsp;Ya\u015fl\u0131 hastalarda atriyal fibrilasyon, ven\u00f6z tromboemboli ve koroner arter hastal\u0131\u011f\u0131 gibi nedenlerle s\u0131k kullan\u0131lan antikoag\u00fclanlar (\u00f6zellikle YOAK&#8217;lar), min\u00f6r travmalarda bile ciddi kanamalara neden olabilir. Kafa travmas\u0131, makroskopik hemat\u00fcri, G\u0130S kanamas\u0131 olan hastalarda bu ila\u00e7lar\u0131n varl\u0131\u011f\u0131 sorgulanmal\u0131 ve gerekirse geri d\u00f6nd\u00fcr\u00fcc\u00fc ajanlar kullan\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n<p><strong>Tedavi Yakla\u015f\u0131m\u0131nda Bireyselle\u015ftirme<\/strong><\/p>\n\n\n\n<p><strong>Risk S\u0131n\u0131fland\u0131rmas\u0131<\/strong><\/p>\n\n\n\n<p>K\u0131r\u0131lganl\u0131k, organ rezervinde azalma, aktivite eksikli\u011fi, k\u00f6t\u00fc beslenme durumu, stres ve\/veya ya\u015flanman\u0131n fizyolojik de\u011fi\u015fikliklerinden kaynaklanan olumsuz sa\u011fl\u0131k sonu\u00e7lar\u0131yla ili\u015fkili azalm\u0131\u015f fizyolojik rezerv durumudur (13).<\/p>\n\n\n\n<p><strong>Hasta kategorileri:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fit (Uygun)<\/strong>: Standart doz yo\u011funlukta kemoimm\u00fcnoterapi adaylar\u0131<\/li>\n\n\n\n<li><strong>Intermediate-fit (Orta uygun)<\/strong>: Modifiye tedavi gerekebilir<\/li>\n\n\n\n<li><strong>Frail (K\u0131r\u0131lgan)<\/strong>: D\u00fc\u015f\u00fck yo\u011funlukta veya destekleyici tedavi<\/li>\n<\/ul>\n\n\n\n<p><strong>Tedavi Planlamas\u0131nda De\u011ferlendirilecek Fakt\u00f6rler:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fonksiyonel durum (kognitif, fiziksel)<\/li>\n\n\n\n<li>Komorbiditeler (diabetes, KVH, demans, renal yetmezlik)<\/li>\n\n\n\n<li>\u0130la\u00e7 etkile\u015fimleri<\/li>\n\n\n\n<li>Kapsaml\u0131 geriatrik de\u011ferlendirme sonu\u00e7lar\u0131<\/li>\n\n\n\n<li>Hastan\u0131n ya\u015fam hedefleri ve tercihleri<\/li>\n<\/ul>\n\n\n\n<p>Hemato-onkologlar ve geriatri uzmanlar\u0131 aras\u0131ndaki i\u015f birli\u011fi ya\u015fl\u0131 hastalar\u0131n y\u00f6netiminin optimize edilmesi i\u00e7in esast\u0131r. Bu multidisipliner yakla\u015f\u0131m, \u00f6nerilen doz tedaviyi tolere edebilecek hastalar\u0131 ve aksine, ya\u015fl\u0131 pop\u00fclasyonun \u00e7ok korktu\u011fu \u00f6zerklik kayb\u0131na yol a\u00e7an ya\u015fam kalitesinde azalmaya neden olabilecek yan etkiler ya\u015fayabilecek hastalar\u0131 belirlememizi sa\u011flar (1).<\/p>\n\n\n\n<p><strong>Acil Serviste Pratik Yakla\u015f\u0131m<\/strong><\/p>\n\n\n\n<p><strong>Triaj ve \u0130lk De\u011ferlendirme<\/strong><\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>Vital bulgular ve mental durum<\/li>\n\n\n\n<li>Anemiye tolerans de\u011ferlendirmesi<\/li>\n\n\n\n<li>Kanama bulgular\u0131n\u0131n ara\u015ft\u0131r\u0131lmas\u0131<\/li>\n\n\n\n<li>Enfeksiyon belirtilerinin de\u011ferlendirilmesi<\/li>\n\n\n\n<li>\u0130la\u00e7 anamnezi (\u00f6zellikle antikoag\u00fclanlar)<\/li>\n<\/ol>\n\n\n\n<p><strong>Laboratuvar \u0130ncelemesi<\/strong><\/p>\n\n\n\n<p><strong>Temel testler:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tam kan say\u0131m\u0131 ve periferik yayma<\/li>\n\n\n\n<li>Kapsaml\u0131 metabolik panel<\/li>\n\n\n\n<li>Koag\u00fclasyon testleri<\/li>\n\n\n\n<li>Ferritin, B12, folat<\/li>\n\n\n\n<li>LDH, \u00fcrik asit<\/li>\n<\/ul>\n\n\n\n<p><strong>\u0130leri tetkikler:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Flow sitometri<\/li>\n\n\n\n<li>Kemik ili\u011fi aspirasyonu\/biopsisi<\/li>\n\n\n\n<li>Sitogenetik incelemeler<\/li>\n<\/ul>\n\n\n\n<p><strong>Tedavi \u00d6ncelikleri<\/strong><\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>Acil durumlar: Kanama kontrol\u00fc, sepsis y\u00f6netimi<\/li>\n\n\n\n<li>Semptomatik destek: Transf\u00fczyon, antibiyoterapi<\/li>\n\n\n\n<li>Spesifik tedavi: Hematoloji kons\u00fcltasyonu sonras\u0131<\/li>\n\n\n\n<li>Geriatrik kons\u00fcltasyon: Uygun hastalarda<\/li>\n<\/ol>\n\n\n\n<p><strong>Gelecek Perspektifleri ve \u00d6neriler<\/strong><\/p>\n\n\n\n<p><strong>Ara\u015ft\u0131rma Alanlar\u0131<\/strong><\/p>\n\n\n\n<p>K\u00fcresel olarak hematolojik malignite vakalar\u0131nda 1990&#8217;dan bu yana art\u0131\u015f g\u00f6r\u00fclmekte olup, 2019&#8217;da 1.343,85 bin vakaya ula\u015fm\u0131\u015ft\u0131r (14). Bu art\u0131\u015f, a\u015fa\u011f\u0131daki alanlarda yo\u011fun ara\u015ft\u0131rma ihtiyac\u0131n\u0131 ortaya koymaktad\u0131r:<\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>Ya\u015fa-uygun tedavi rejimlerinin geli\u015ftirilmesi<\/li>\n\n\n\n<li>Geriatrik de\u011ferlendirme ara\u00e7lar\u0131n\u0131n standardizasyonu (9)<\/li>\n\n\n\n<li>Molek\u00fcler hedefli tedavilerin ya\u015fl\u0131larda optimizasyonu<\/li>\n\n\n\n<li>Yapay zeka destekli risk s\u0131n\u0131fland\u0131rmas\u0131 (2)<\/li>\n<\/ol>\n\n\n\n<p><strong>Sa\u011fl\u0131k Sistemi D\u00fczeyinde \u00d6neriler<\/strong><\/p>\n\n\n\n<p>D\u00fc\u015f\u00fck-orta gelir d\u00fczeyindeki \u00fclkelerde geriatrik hematoloji programlar\u0131n\u0131n uygulanmas\u0131 i\u00e7in sistematik yakla\u015f\u0131mlar gereklidir.<\/p>\n\n\n\n<p><strong>\u00d6nerilen stratejiler:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Multidisipliner geriatrik hematoloji kliniklerinin kurulmas\u0131<\/li>\n\n\n\n<li>Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na y\u00f6nelik e\u011fitim programlar\u0131<\/li>\n\n\n\n<li>Hasta ve hasta yak\u0131n\u0131 e\u011fitim materyallerinin geli\u015ftirilmesi<\/li>\n\n\n\n<li>Telemedicine uygulamalar\u0131n\u0131n yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131<\/li>\n<\/ul>\n\n\n\n<p><strong>Sonu\u00e7<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 bireylerde hematolojik hastal\u0131klar, genellikle altta yatan ba\u015fka sorunlar\u0131n g\u00f6lgesinde kalabilir (3). Modern yakla\u015f\u0131m, sadece hastal\u0131\u011f\u0131n tedavisi de\u011fil, hastan\u0131n t\u00fcm ya\u015fam kalitesini g\u00f6z \u00f6n\u00fcnde bulunduran kapsaml\u0131 bir de\u011ferlendirmeyi gerektirir (8).<\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda geriatrik de\u011ferlendirmenin entegre edilmesi, tedavi tolerans\u0131n\u0131 ve faydas\u0131n\u0131 tahmin etmede yararl\u0131 oldu\u011fu kan\u0131tlanm\u0131\u015ft\u0131r. Acil servis hekimi, bu hastalarda klasik semptomlar\u0131 ararken, ya\u015flanman\u0131n getirdi\u011fi fizyolojik farkl\u0131l\u0131klar\u0131 da g\u00f6z \u00f6n\u00fcnde bulundurmal\u0131d\u0131r (13).<\/p>\n\n\n\n<p><strong>Temel prensipler:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ya\u015fl\u0131l\u0131k bir hastal\u0131k de\u011fil; \u00f6zel yakla\u015f\u0131m gerektiren fizyolojik bir s\u00fcre\u00e7tir (2)<\/li>\n\n\n\n<li>Her ya\u015fl\u0131 hasta benzersizdir ve bireysel de\u011ferlendirme gerektirir (6,9)<\/li>\n\n\n\n<li>Multidisipliner yakla\u015f\u0131m ba\u015far\u0131n\u0131n anahtar\u0131d\u0131r (3,14)<\/li>\n\n\n\n<li>Geriatrik de\u011ferlendirme tedavi planlamas\u0131n\u0131n ayr\u0131lmaz par\u00e7as\u0131 olmal\u0131d\u0131r (8,9)<\/li>\n<\/ul>\n\n\n\n<p>Gelecekte, ya\u015flanan n\u00fcfusla birlikte hematoloji hizmetlerine olan talep dramatik \u015fekilde artacakt\u0131r. Bu meydan okumayla ba\u015fa \u00e7\u0131kabilmek i\u00e7in, \u015fimdiden proaktif stratejiler geli\u015ftirmek, uygun say\u0131da sa\u011fl\u0131k profesyonelini e\u011fitmek ve gerekli ara\u015ft\u0131rmalar\u0131 y\u00f6nlendirmek gerekecektir.<\/p>\n\n\n\n<p><strong>Kaynaklar<\/strong><\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>Scheepers ERM, Vondeling AM, Thielen N, van der Griend R, Stauder R, Hamaker ME. Geriatric assessment in older patients with a hematologic malignancy: a systematic review. Haematologica. 2020;105(6):1484-1493. doi: 10.3324\/haematol.2019.245803.<\/li>\n\n\n\n<li>Caserta S, Cancemi G, Loreta S, Allegra A, Stagno F. Hematological Malignancies in Older Patients: Focus on the Potential Role of a Geriatric Assessment Management. Diagnostics. 2024;14(13):1390. doi: 10.3390\/diagnostics14131390.<\/li>\n\n\n\n<li>Walsh JR. Hematologic disorders in the elderly. West J Med. 1981;135(6):446-454. PMID: 6801866.<\/li>\n\n\n\n<li>Rosenblum D. Hematologic Disease in the Elderly. The Hematologist. 2006;3(2):No Pagination Specified. doi: 10.1182\/hem.V3.2.6025.<\/li>\n\n\n\n<li>Watts JM, Baer MR, Yang J, et al. Older Adults with Aggressive Blood Cancer are Responsive to Treatment and Show Prolonged Survival. Press Release, American Society of Hematology. 2024 May 9.<\/li>\n\n\n\n<li>Torka P, Drill E, Ganesan N, et al. A Prospective Geriatric Assessment (GA) Study Predicting Toxicities in Older Adults (OA) with Non-Hodgkin Lymphoma (NHL): Timed up and Go Test (TUG) Time Emerges As a Functional Vital Sign. Blood. 2024;144(Supplement 1):4474.<\/li>\n\n\n\n<li>Hamaker ME, Mitrovic M, Stauder R. The G8 screening tool detects relevant geriatric impairments and predicts survival in elderly patients with a haematological malignancy. Ann Hematol. 2014;93(9):1533-1540. doi: 10.1007\/s00277-014-2103-0.<\/li>\n\n\n\n<li>Klepin HD. Ready for prime time: role for geriatric assessment to improve quality of care in hematology practice. Blood. 2019;134(25):2005-2012. doi: 10.1182\/hematology.2019001299.<\/li>\n\n\n\n<li>Bonanad S, De la Rubia J, Gironella M, et al. Development and psychometric validation of a brief comprehensive health status assessment scale in older patients with hematological malignancies: The GAH Scale. J Geriatr Oncol. 2015;6(5):353-361. doi: 10.1016\/j.jgo.2015.03.003.<\/li>\n\n\n\n<li>Wildiers H, Heeren P, Puts M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014;32(24):2595-2603. doi: 10.1200\/JCO.2014.56.3214.<\/li>\n\n\n\n<li>Parks AL. Anticoagulation at the end of life: whether, when, and how to treat. Hematology Am Soc Hematol Educ Program. 2024;2024(1):348-354. doi: 10.1182\/hematology.2024000559.<\/li>\n\n\n\n<li>Orkaby AR, Gaziano JM. Oral anticoagulant therapy in older adults. Thromb Res. 2024;238:74-85. doi: 10.1016\/j.thromres.2024.04.009.<\/li>\n\n\n\n<li>Mohile SG, Dale W, Somerfield MR, et al. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol. 2018;36(22):2326-2347. doi: 10.1200\/JCO.2018.78.8687.<\/li>\n\n\n\n<li>Zheng R, Zhang S, Zeng H, et al. Global burden of hematologic malignancies and evolution patterns over the past 30 years. Blood Cancer J. 2023;13(1):82. doi: 10.1038\/s41408-023-00853-3.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Yazar:\u00a0Do\u00e7.Dr.Mehmet Altunta\u015f Edit\u00f6r: Prof.Dr. \u00d6zlem K\u00f6ksal D\u00fcnya ya\u015flan\u0131yor ve bu durum sa\u011fl\u0131k alan\u0131nda yeni zorluklarla kar\u015f\u0131m\u0131za \u00e7\u0131k\u0131yor. \u00d6zellikle hematolojik hastal\u0131klar konusunda bu&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":716,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10020,10018,10060],"class_list":["post-715","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-tip","tag-geriatri","tag-hematoloji"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/715","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=715"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/715\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/716"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=715"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=715"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=715"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}