The aging human recipient of transfusion products.
In this review the different mechanisms of aging and frailty such as DNA defects due to impaired DNA repair, inflammatory processes, disturbances of oxidative phosphorylation are discussed together with mechanisms of cell repair. Components of blood plasma, such as the growth-differentiation protein GDF11, were shown to enhance neurogenesis and to improve the vasculature in the animal cortex and to rejuvenate muscle tissue. Advances in laboratory assays allow to identify plasma proteins that may affect tissue regeneration. This new knowledge from animal research might affect transfusion practice in geriatric patients in the future. Provided it can be translated and confirmed in human research, blood products might no longer be considered only as oxygen carriers or drugs to improve hemostasis. In the present time blood transfusion (RBCs, plasma or platelets) should be directed by differentiated guidelines considering not only cut-off values of hemoglobin, platelet count or coagulation but also old age-specific biologic variation, comorbidities and the clinical context e.g. of bleeding.
Labormedizinisches Zentrum Dr. Risch, Bern-Liebefeld, Switzerland. Electronic address: urs.nydegger@risch.ch.
Urs E
UE
Nydegger
Department of Anaesthesiology, Bern Hospital Network, University of Bern, Bern, Switzerland.
Martin
M
Luginbühl
Central Laboratory, Kantonsspital Graubünden, Chur, Switzerland.
Martin
M
Risch
D000368:Aged; D000375:Aging; D016913:Blood Component Transfusion / Q000379:methods*; D001798:Blood Proteins / Q000737:chemistry; D001803:Blood Transfusion / Q000379:methods; D019485:Bone Morphogenetic Proteins / Q000378:metabolism; D004260:DNA Repair; D005260:Female; D055412:Growth Differentiation Factors / Q000378:metabolism; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000517:prevention & control; D006487:Hemostasis; D006801:Humans; D007249:Inflammation; D008297:Male; D008833:Microcirculation; D010100:Oxygen / Q000737:chemistry; D010766:Phosphorylation; D010949:Plasma; D010976:Platelet Count; D017713:Platelet Transfusion / Q000379:methods; D012038:Regeneration; D012307:Risk Factors
D001798:Blood Proteins; D019485:Bone Morphogenetic Proteins; C492266:GDF11 protein, human; D055412:Growth Differentiation Factors; D006454:Hemoglobins; D010100:Oxygen