Mitha Nathalie, Monti Alexandra, Chaibi Pascal, Gouronnec Adeline, Breining Alice, Pautas Eric
Groupe hospitalier Pitié-Salpêtrière-Charles-Foix (AP-HP), hôpital Charles-Foix, unité d'onco-hémato-gériatrie, 94205 Ivry-sur-Seine cedex, France.
Groupe hospitalier Pitié-Salpêtrière-Charles-Foix (AP-HP), hôpital Charles-Foix, service de court séjour gériatrique, 94205 Ivry-sur-Seine cedex, France.
Presse Med. 2014 Oct;43(10 Pt 1):e251-6. doi: 10.1016/j.lpm.2014.03.024. Epub 2014 Jul 2.
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.
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.
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).
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.
老年贫血患者的红细胞输血需要考虑血红蛋白阈值以及可能因贫血而失代偿的合并症。在老年人群中缺乏关于输血的共识性指征的情况下，评估老年医学中输血的实际方法似乎很重要。我们分析了一家老年教学医院中住院的高龄患者的红细胞输血处方。
这项回顾性研究基于一年内收集的736份红细胞输血处方中的信息。收集并分析了血红蛋白水平、红细胞单位数量以及开处方医生提供的临床信息。
红细胞输血前的平均血红蛋白水平为8.45±0.94g/dL。有两个变量与输血阈值升高至9g/dL以上显著相关：贫血耐受性差（P<10⁻⁴）和存在贫血耐受性差风险的临床情况（P=0.0076）。贫血耐受性差最常见的症状是心血管症状以及急性神经精神症状，这些可被视为老年人红细胞输血的特定标准。每次输血开具的红细胞单位平均数量为1.88±0.55，唯一的预测因素是血红蛋白水平（P<0.001）。
在我们的老年医学实践中，输血阈值和输血后的目标血红蛋白水平似乎与2002年由法国社会保险产品评估局编辑的唯一可用的法国指南中推荐的阈值相当。然而，我们的研究指出了红细胞输血处方中的特定老年医学特点，即使用了一些似乎与非心血管合并症相关的耐受性标准。未来可以进行前瞻性干预研究，以评估这些潜在的特定老年医学标准在输血指征中的临床相关性。
