Blood management in older adults questioned

USC academic Geoff Simon in the lab.

USC-led research exploring blood management in older patients with anaemia and blood loss has raised questions around the current recommended medical care approach.

Lead author and USC academic Geoff Simon said current worldwide adult medical guidelines for blood transfusions are based mainly on data from people under the age of 65.

“Blood management in older adults who are sick is not something that has been widely studied and therefore a lot of the guidance for these patients uses a one-size-fits-all type approach,” Mr Simon said.

“Often this means that the restrictive, or lower, haemoglobin thresholds that guide blood use for people under 65 don’t work as well as they could for older patients,” he said.

“It is great to see that transfusion rates are going down in general as per blood management guidelines, but our research suggests that we could be managing things differently for better outcomes in older adults.”

Geoff Simon said anaemia is associated with worse outcomes in older adults, but the reasons are not well understood. The USC research has focussed on changes in oxygen delivery to the body with older age due to factors such as falling cardiac performance.

“Our research analysed the use of blood in older patients based on some international trials. We found that the older patients who were managed with haemoglobin levels around 100 g per litre had a lower mortality rate and had fewer cardiac complications than those managed around 70 or 80 g per litre,” Mr Simon said.

“We then reviewed further evidence to explore the biological reasons behind differences in transfusion trial outcomes related to haemoglobin thresholds in different age groups,” he said.

“Based on those findings the research team predicted that older adults require a haemoglobin of 100g per litre to achieve the same oxygen delivery potential as a younger patient with haemoglobin of 70g per litre.

“We believe this indicates the need for patient blood management guidance to be much more specific to older adults, and distinct from younger adults.

“It reinforces the need to conserve the patients’ blood and to investigate and treat the causes of anaemia in older adults, so they are better able to cope with physical demands.

“This could offer much better outcomes to older patients with anaemia both in a hospital setting but also in community settings to better their quality of life.”

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