Siriwardana M, Moulias S, Benisty S, Pautas E, Paccalin M, Tigoulet F, Durand-Gasselin B, Dalco O, Senet P, Debray M, Bloch F, Yvain F, Verny C, Heriche-Taillandier E, Verny M, Boddaert J
Service de gérontologie 4, hôpital Charles-Foix, 94200 Ivry-sur-Seine, France.
Rev Med Interne. 2010 Feb;31(2):91-6. doi: 10.1016/j.revmed.2009.10.432. Epub 2009 Dec 16.
In the absence of specific recommendations on blood transfusion in elderly subjects, we carried out a survey to assess transfusion practices in geriatric medicine.
A descriptive, national, cross-sectional survey was conducted in 14 French geriatric departments (12 teaching hospitals and two general hospitals). In each department, five patients receiving transfusions were randomly selected in order to analyze their characteristics, the indications of blood transfusion, the criteria for and the methods of transfusion compared with Afssaps recommendations on transfusion thresholds.
Data were analyzed for 70 patients (mean age 86+/-7 years, sex ratio female to male 1.8, with an average of five+/-two pathologies and six+/-three treatments). The indicators of poor tolerance included confusion (23 %), somnolence (22 %), acute heart failure (17 %) or coronary heart disease (16 %), and differed from the Afssaps criteria in the majority of cases. The transfusion threshold that were considered in the absence of poor tolerance (45 % of transfusions) differed from that recommended by Afssaps in 26 % of cases. The main adverse event in transfusion recipients was heart failure.
When criteria for poor anaemia tolerance or transfusion thresholds are considered, transfusion practices in geriatric subjects have specific features. Further studies are needed to validate the appropriateness of the practices described in this survey.
鉴于缺乏针对老年患者输血的具体建议，我们开展了一项调查以评估老年医学中的输血实践情况。
在法国14个老年科（12家教学医院和2家综合医院）进行了一项描述性的全国横断面调查。在每个科室中，随机选择5名接受输血的患者，以分析其特征、输血指征、与法国卫生安全与健康产品局（Afssaps）输血阈值建议相比的输血标准和方法。
对70名患者的数据进行了分析（平均年龄86±7岁，女性与男性的性别比为1.8，平均有5±2种病症和6±3种治疗）。耐受性差的指标包括意识模糊（23%）、嗜睡（22%）、急性心力衰竭（17%）或冠心病（16%），在大多数情况下与Afssaps标准不同。在无耐受性差的情况下所考虑的输血阈值（45%的输血情况）在26%的病例中与Afssaps建议的不同。输血接受者的主要不良事件是心力衰竭。
在考虑贫血耐受性差的标准或输血阈值时，老年患者的输血实践有其特点。需要进一步研究以验证本调查中所描述实践的适当性。
