title: [Analysis of 736 blood transfusions in a geriatric teaching hospital].
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Groupe hospitalier Pitié-Salpêtrière-Charles-Foix (AP-HP), hôpital Charles-Foix, unité d'onco-hémato-gériatrie, 94205 Ivry-sur-Seine cedex, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Mitha
authors.affiliation: Groupe hospitalier Pitié-Salpêtrière-Charles-Foix (AP-HP), hôpital Charles-Foix, service de court séjour gériatrique, 94205 Ivry-sur-Seine cedex, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Monti
authors.affiliation: Groupe hospitalier Pitié-Salpêtrière-Charles-Foix (AP-HP), hôpital Charles-Foix, unité d'onco-hémato-gériatrie, 94205 Ivry-sur-Seine cedex, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Chaibi
authors.affiliation: Groupe hospitalier Pitié-Salpêtrière-Charles-Foix (AP-HP), hôpital Charles-Foix, service de court séjour gériatrique, 94205 Ivry-sur-Seine cedex, France.
authors.forename: Adeline
authors.initials: A
authors.lastname: Gouronnec
authors.affiliation: Groupe hospitalier Pitié-Salpêtrière-Charles-Foix (AP-HP), hôpital Charles-Foix, service de court séjour gériatrique, 94205 Ivry-sur-Seine cedex, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Breining
authors.affiliation: Groupe hospitalier Pitié-Salpêtrière-Charles-Foix (AP-HP), hôpital Charles-Foix, service de court séjour gériatrique, 94205 Ivry-sur-Seine cedex, France; Faculté de médecine Pierre-et-Marie-Curie, Paris 6, Paris, France. Electronic address: eric.pautas@cfx.aphp.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Pautas
mesh_terms: D000368:Aged; D000740:Anemia / Q000628:therapy*; D001803:Blood Transfusion / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006299:Health Services for the Aged; D006454:Hemoglobins / Q000032:analysis*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins