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Study raises concerns over elderly blood management

Research from the University of the Sunshine Coast (USC) has raised concerns around blood management in older patients with anaemia and blood loss, as most seniors are recommended a “one-size-fits-all” approach to medical care.

Geoff Simon, USC Academic, believes blood management in older patients with anaemia and blood loss is concerning with most seniors receiving “one-size-fits-all” medical care. [Source: USC Australia]
Geoff Simon, USC Academic, believes blood management in older patients with anaemia and blood loss is concerning with most seniors receiving “one-size-fits-all” medical care. [Source: USC Australia]

The research, Impacts of Ageing on Anaemia Tolerance, Transfusion Thresholds and Patient Blood Management, was published in the Transfusion Medicine Review recently.

USC Academic and Lead Author of the research, Geoff Simon, found that the current adult medical guidelines for blood transfusions are based on data from people under the age of 65.

Mr Simon explains, “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.”

“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.

“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.” 

Mr Simons explains that anaemia is associated with worse outcomes in older adults, but the reasons for this are not well known.

The research looked into changes in oxygen delivery around older bodies because of falling cardiac performance, which is a common occurrence in people as they age because their cardiac output declines.

Analysing the blood use in older patients based on international trials, the research found that older patients with haemoglobin levels around 100g per litre had lower mortality rates and few cardiac issues compared to older people with haemoglobin levels around 70 to 80g per litre. 

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

“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.”

Mr Simons adds that this reinforces the need to treat the cause of anaemia in an older patient, and conserve the patients’ blood for investigation, so they can better tackle the issue and help the older person 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,” says Mr Simons.

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