[Indicators of transfusion decision in acute geriatric ward with an exclusive emergency room recruitment]

Abstract

Objective: Description of the transfusion practice and its specificities in a geriatric unit.

Patients and methods: Prospective descriptive study realized by a single consultant.

Inclusion criteria: patients admitted in the unit between 01/10/2011 and 31/01/2012 with hemoglobin level below 10 g/dL.

Results: Eighty-one patients: 87.7-year-old±5.6, ADL 2.1±1.9. CIRS 15.5±3.9. Forty-five (55.5%) of the patients received blood transfusion. Cause of admittance: anemia for 9% of patients. The etiology of anemia was multifactorial in the majority of cases. Admission hemoglobin rate: 9.1 g/dL±1.1 in transfused group versus 9.6 g/dL±0.5 for non-transfused patients. The clinical signs of anemia were asthenia (98.8%), impact on everyday activities (91.4%), respiratory distress (60.5%), stability disturbances and falls (38.3%), confusion (32.1%), hemodynamic disorders (29.6%). The increase of hemoglobin rate was 1.45 g/dL in the transfused group versus 0.3 g/dL for the non-transfused patients. A side effect was observed in 2 transfused patients (4.4%).

Discussion: Transfusion decision criteria are rarely studied in geriatrics. The clinical signs of anemia include the classical hemodynamic disorders, cardio-respiratory and more specific of the elderly patients as confusion, majoring of cognitive decline and falls. The transfusion threshold (1.4 g/dL per 1 RBC unit) seems higher than in the overall transfused patients. Transfusion remains the fastest way to correct anemia but exposes to circulatory overload.

Keywords: Anemia; Anémie; Court séjour gériatrique; Décision transfusionnelle; Elderly patients; Geriatric unit; Sujet âgé; Tolerance; Tolérance; Transfusion; Transfusion decision.