Blood transfusion in older patients.

Anaemia is the most frequent haematological disease in older patients with prevalence up to 60% among patients hospitalized in acute geriatric ward. Furthermore, people aged 65 years and over receive more than half of the blood transfusion. The tolerance and the symptom of anaemia in older patients are very variable from one patient to another depending on ageing and comorbidities. The transfusion decision should not be based on haemoglobin levels but should be based on the benefit/risk balance taking into account patients' symptoms due to anaemia, benefit and expected efficacy as well as risk of the transfusion in this comorbid population. Indeed, adverse events of red blood cell transfusion are more frequent in older patients. However, several studies showed a lower mortality in liberal transfusion strategy than restrictive strategy especially in surgical ward. Beside the development of alternative treatment of anaemia, further geriatric-specific studies which includes geriatric syndromes are needed to guide development of specific guidelines for older patients in surgical and in medical wards. With the lack of strong and comprehensive data, one should continue to evaluate the risk to benefit ratio in each older individual, bearing in mind that the blood should be transfused more slowly and on a unit by unit basis.