Enquête transversale sur la transfusion dans les services de gériatrie

[Appropriate use of red blood cell transfusion in the emergency department before and after a specific protocol]

The purpose of this study was to assess appropriateness of red blood cell (RBC) transfusion in the emergency department before and after a specific protocol.

METHODS

A retrospective monocenter study was realized during two six-month periods at the emergency unit. A protocol based on the French national guidelines (HAS) in 2014 was set up between the two periods. All the adult patients, except in a context of massive transfusion, were included in the study. The principal criteria analysed was the rate of appropriate transfusion.

RESULTS

Ninety-five patients were included during the first period (group 1) and 98 during the second one (group 2). The rate of appropriateness was the same in the two groups (81% for the group 1 and 81.6% for the group 2). The inappropriate indications were more frequent with older patients (74.6 ± 15.2 years in the group 1 and 79.5 ± 8.5 in the group 2, P=0.01) and patients suffering from a stable coronary artery disease (18.5% in the group 1 and 38.9% in the group 2, P=0.008).

CONCLUSION

The rate of appropriate red blood cells transfusion, already high at the beginning of the study, could not be significantly improved with the institution of a specific protocol. It is necessary to continue medical training.

[Transfusion practices in elderly patients: A descriptive study about 241 patients at the university hospital of Brest]

Red blood cell transfusion is commonly required for elderly patients with little specific guidelines for this population. We wished to study the transfusion practices for patients aged≥75 years transfused with red blood cells in all units of our institution. The aim of this work is to describe this population of patients and to compare the transfusion practices to the HAS and ANSM guidelines published in 2014.

METHODS

An observational study was performed including patients≥75 years, transfused with red blood cells between 27th January to 27th March 2014. Analysis of data included the patients' typology, the characteristics of anemia, the indications and transfusion practices, and the adequation with the guidelines.

RESULTS

Two hundred and forty-one patients were transfused during the period with 422 transfusion episodes (mean age 83±5.2 years, sex-ratio women/men 1.4 with 4.4±2 pathologies and 6.7±3.2 treatments). Only 4.5% of the patients were transfused in geriatric wards. In 61% of the cases, the anemia is acute and chronic in 39%. Fatigue was reported in 50.6% of the cases and dyspnee in 31.7%. A percentage of 31.1 of the patients were prescribed furosemide for transfusion. The mean transfusion recovery was 1.2±0.5g/dL. Two adverse events were reported. Overall, only 10.4% of the prescriptions were not compliant with the guidelines of 2014.

CONCLUSION

In this study, we describe transfusion practices for patients aged≥75 years. Although the non-compliance with the guidelines is weak, it is possible to improve the transfusion practices taking care of the geriatric characteristics. Prospective studies on a larger scale have to be done to converge on a more consensual management.

[Indicators of transfusion decision in acute geriatric ward with an exclusive emergency room recruitment]

OBJECTIVE

Description of the transfusion practice and its specificities in a geriatric unit.

PATIENTS AND METHODS

Prospective descriptive study realized by a single consultant.

INCLUSION CRITERIA

patients admitted in the unit between 01/10/2011 and 31/01/2012 with hemoglobin level below 10 g/dL.

RESULTS

Eighty-one patients: 87.7-year-old±5.6, ADL 2.1±1.9. CIRS 15.5±3.9. Forty-five (55.5%) of the patients received blood transfusion. Cause of admittance: anemia for 9% of patients. The etiology of anemia was multifactorial in the majority of cases. Admission hemoglobin rate: 9.1 g/dL±1.1 in transfused group versus 9.6 g/dL±0.5 for non-transfused patients. The clinical signs of anemia were asthenia (98.8%), impact on everyday activities (91.4%), respiratory distress (60.5%), stability disturbances and falls (38.3%), confusion (32.1%), hemodynamic disorders (29.6%). The increase of hemoglobin rate was 1.45 g/dL in the transfused group versus 0.3 g/dL for the non-transfused patients. A side effect was observed in 2 transfused patients (4.4%).

DISCUSSION

Transfusion decision criteria are rarely studied in geriatrics. The clinical signs of anemia include the classical hemodynamic disorders, cardio-respiratory and more specific of the elderly patients as confusion, majoring of cognitive decline and falls. The transfusion threshold (1.4 g/dL per 1 RBC unit) seems higher than in the overall transfused patients. Transfusion remains the fastest way to correct anemia but exposes to circulatory overload.

[Analysis of 736 blood transfusions in a geriatric teaching hospital]

BACKGROUND

Red blood cell transfusion in elderly patients with anemia requires taking into account a hemoglobin threshold, as well as comorbidities that may be decompensated by anemia. In the absence of consensual indications for blood transfusion in the elderly population, it seems important to evaluate the practical approach of blood transfusion in geriatrics. We analyzed prescriptions of red blood cell transfusion in very old patients hospitalized in a geriatric teaching hospital.

METHODS

This retrospective study was based on information collected during one year in 736 red blood cell transfusion prescriptions. Hemoglobin levels, numbers of red blood cell units and clinical informations notified by prescribing physicians have been collected and analyzed.

RESULTS

The mean hemoglobin level before red blood cell transfusion was 8.45±0.94g/dL. Two variables were significantly associated with an increase of the transfusion threshold above 9g/dL: the poor tolerance of anemia (P<10(-4)) and clinical situations at risk for poor tolerance of anemia (P=0.0076). The most frequent symptoms of poor tolerance of anemia were cardiovascular symptoms and also acute neuropsychiatric symptoms that could be considered as specific criteria for the red cell transfusion in the elderly. The mean number of red blood cell units prescribed for each transfusion was 1.88±0.55 and the only predictive factor was the hemoglobin level (P<0.001).

PERSPECTIVES

In our geriatric practice, transfusion thresholds and target hemoglobin levels after transfusion seemed to be comparable with the thresholds recommended in the only available French guidelines edited in 2002 by the Afssaps. However, our study pointed out specific geriatric particularities in red blood cell transfusion prescriptions with the use of some tolerance criteria that seem related to non-cardiovascular comorbidities. Future prospective interventional studies could be conducted in order to evaluate the clinical relevance of these potential specific geriatric criteria in transfusion indications.