Hematologic Changes with Aging

The hematologic system is comprised of blood and blood forming tissues, including the bone marrow, liver, spleen, thymus, and the lymphatic system. It serves important roles in oxygen and nutrient delivery, waste removal, pH balance, fluid regulation, coagulation, and inflammatory and immune functions among other roles. As aging occurs, the hematologic system becomes increasingly susceptible to development of anemia, myeloproliferative disorders, disorders of coagulation, and immunosenescence and immune dysfunction. The endothelium also plays a key role in the hematologic system, maintaining blood flow, vascular homeostasis, and regulation of coagulation. Endothelial senescence contributes to atherosclerotic and pro-inflammatory changes which may lead to atherosclerotic plaque rupture with disruption of the endothelial lining, exposure to prothrombotic subendothelial matrix, and formation of an occlusive thrombus resulting in adverse cardiovascular events in the elderly, such as myocardial infarction and stroke. Many geriatric patients are prescribed antiplatelet and anticoagulation medications to prevent thrombotic events. These agents may increase the risk and severity of hemorrhagic events; thus, the trauma surgeon must be familiar with these agents and measures to counteract their anticlotting effects.