Transfusion medicine

Blood transfusion guidelines needed for the elderly

Queensland experts are calling for age-specific blood transfusion guidelines after their review found more liberal  strategies produced better outcomes in older patients than the current restrictive transfusion strategies.

According to the systematic review and meta-analysis published in The Lancet Haematology, 30-day mortality, 90-day mortality and cardiovascular complications were improved when patients over 65 years were managed with a more liberal transfusion strategy.

Other outcomes such as infection and hospital length of stay were unaffected by the transfusion strategy.

The review comprised nine randomised controlled trials – three trials in exclusively over 65-year-olds and another six trials, which also included younger patients but maintained a mean age of at least 64 years.

A sub-analysis of the three trials with only older patients found the 30-day mortality risk ratio of 2.07 significantly favoured the liberal transfusion strategy.

However when the nine trials were analysed together, the risk ratio dropped to 1.36 while retaining significance.

Researcher and transfusion expert Mr Geoff Simon, from the School of Health and Sports Sciences at the University of the Sunshine Coast, told the limbic that previous studies, which were further diluted with younger patients, found no mortality difference based on transfusion strategy.

The pivotal TRICC study, which heralded restrictive transfusion practice, included all ages from 18 years.

Mr Simon and colleagues have called for further research to formulate evidence-based transfusion practice across clinical specialties specific to the geriatric population.

“Recognising the accumulation of comorbidities and changes in physiological function and capacity with age, we postulate that specific patient blood management guidance is warranted for this older population,” he said.

 “We have a paediatric guideline which is entirely appropriate because their physiology is different, and their requirements are different and that is what that guideline is recognising.”

“Once people get to over 65 years, blood use escalates significantly and therefore it is appropriate that we really consider carefully whether we need specific guidance for older adults.”

“We have an ageing population and we need to be thinking and projecting forward.”

A Comment article suggested the review had not included all eligible trials, which if included, would have affected the findings.

However they agreed there were questions about the ‘general adoption of restrictive red blood cell transfusions for elderly patients based on the results of RCTs, which have included patients with broad age ranges’.

It also highlighted that a more liberal transfusion strategy would lead to additional demand on blood resources.

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