Pellerey Magali, Couderc Anne Laure, Pauly Vanessa, Gayet Stephane, Leveque Pierre, Mizzi Barbara, Gobin Nirvina, Caunes Pierre, Clapasson Christine, Chiaroni Jacques, Daumas Aurelie, Villani Patrick
Service de médecine interne, gériatrie et thérapeutique, Université Aix-Marseille, AP-HM, Hôpital de La Timone, Marseille, France.
Service de médecine interne, gériatrie et thérapeutique, Université Aix-Marseille, AP-HM, Hôpital de Sainte Marguerite, Marseille, France.
Geriatr Psychol Neuropsychiatr Vieil. 2018 Dec 1;16(4):367-375. doi: 10.1684/pnv.2018.0759.
Anemia is the most common hematological pathology in geriatrics. Its prevalence increases with age. It is considered as a fragility factor because leading to loss of autonomy and other complications. Transfusion is a common practice in geriatrics. In 2014, the French national health authority guidelines recommended hemoglobin concentration rates for transfusion on the elderly over 80 years-old. The objective of this study is to compare transfusion practices in geriatric short-stay units, before and after these guidelines were edited.
Retrospective descriptive study in two geriatric short stay units, including patients aged 80 years-old or over, transfused in 2012 and 2015.
103 patients were included. More than 30% patients had a chronic heart failure, and there was no significant difference on general characteristics between the groups in the two years. Compared to 2012, the transfused population in 2015 was more fragile with a higher Charlson comorbidity index (p=0.005). The main symptoms of anemia bad tolerance were cardiovascular symptoms. The average pre-transfusion hemoglobin concentration was 7.9 g/dL in 2015, 8 g/dL in 2012 (p=0.63). By 2015, 72.3% transfusions respected the hemoglobin thresholds recommended in guidelines, compared to 50% in 2012 (p=0.023). Transfusion thresholds in our study were lower than those recommended; 13 adverse reactions were identified, 12 of them were heart failure. There was no significant difference in transfusion benefit between the two years.
This study helped describe profile of elderly transfused patients, their geriatric characteristics and the transfusion data, without showing any changes in transfusion practices following the guidelines, despite a more fragile population in 2015. It seems difficult, because of the diversity in the geriatric population, to have a single threshold of hemoglobin recommended, only non-specific symptoms of intolerance and to consider only the cardiovascular comorbidities to decide whether or not to provide a transfusion.
贫血是老年医学中最常见的血液学病理状况。其患病率随年龄增长而增加。它被视为一种脆弱因素，因为会导致自主性丧失和其他并发症。输血在老年医学中是一种常见做法。2014年，法国国家卫生当局指南推荐了80岁以上老年人输血的血红蛋白浓度标准。本研究的目的是比较这些指南发布前后老年短期住院病房的输血做法。
在两个老年短期住院病房进行回顾性描述性研究，纳入2012年和2015年接受输血的80岁及以上患者。
共纳入103例患者。超过30%的患者患有慢性心力衰竭，两年间两组患者的一般特征无显著差异。与2012年相比，2015年接受输血的人群更脆弱，查尔森合并症指数更高（p = 0.005）。贫血耐受性差的主要症状是心血管症状。2015年输血前血红蛋白平均浓度为7.9 g/dL，2012年为8 g/dL（p = 0.63）。到2015年，72.3%的输血符合指南推荐的血红蛋白阈值，2012年为50%（p = 0.023）。我们研究中的输血阈值低于推荐值；共识别出13例不良反应，其中12例为心力衰竭。两年间输血获益无显著差异。
本研究有助于描述老年输血患者的概况、其老年病特征和输血数据，尽管2015年的人群更脆弱，但未显示出指南发布后输血做法有任何变化。由于老年人群的多样性，似乎很难制定单一的血红蛋白推荐阈值，仅依据不耐受的非特异性症状并仅考虑心血管合并症来决定是否进行输血。
