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  1. Article ; Online: Unplanned blood use within 24 hours of emergency department presentation: A cohort study in an ageing population.

    Simon, Geoff I / Craswell, Alison / Thom, Ogilvie / Fung, Yoke Lin

    Emergency medicine Australasia : EMA

    2021  Volume 34, Issue 2, Page(s) 244–251

    Abstract: Objective: This research aims to elucidate drivers of blood use in an older population, with a focus on unplanned transfusions following ED presentation.: Methods: In a retrospective cohort study we examined 2015 data for ED presentations and blood ... ...

    Abstract Objective: This research aims to elucidate drivers of blood use in an older population, with a focus on unplanned transfusions following ED presentation.
    Methods: In a retrospective cohort study we examined 2015 data for ED presentations and blood use in two hospitals serving a population containing a high proportion (21%) of adults aged ≥65 years. Unplanned blood use was defined as any transfusion ≤24 h of presentation. Data were analysed by age, sex, Major Diagnostic Category, triage category and time to transfusion.
    Results: A total of 5294 blood components were transfused, comprising red cells (n = 3784), fresh frozen plasma (n = 657), platelets (n = 563) and cryoprecipitate (n = 290). Men aged ≥65 years were the highest users (40%, 2107 components). Unplanned transfusions accounted for 28% (n = 1057) of annual red cell use. Of 85 014 ED presentations, 494 (0.6%) were associated with unplanned red cell transfusion. Four Major Diagnostic Categories accounted for 81% (n = 853) of unplanned red cell use: gastrointestinal (n = 375), haematology (n = 267), trauma (n = 144) and cardiovascular (n = 67). Over one-fifth of unplanned transfusions (21%, n = 222 of 1057) were associated with ICD-10 codes for anaemia as a reason for presentation within the Haematology Major Diagnostic Category. Adults aged ≥65 years accounted for 62% of overall red cell use and 61% of transfusions ≤24 h of presentation. Odds of unplanned red cell transfusion increased with age, peaking at odds ratio 28.5 (95% confidence interval 14.2-57.4) in those aged 85 years and above.
    Conclusions: Unplanned blood use accounted for 28% of annual hospital blood consumption. Blood component use increased with age and was greatest in older men. A significant burden of anaemia treatment was identified by the ED.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Aging ; Cohort Studies ; Emergency Service, Hospital ; Humans ; Male ; Retrospective Studies ; Triage
    Language English
    Publishing date 2021-09-26
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2161824-0
    ISSN 1742-6723 ; 1742-6731 ; 1035-6851
    ISSN (online) 1742-6723
    ISSN 1742-6731 ; 1035-6851
    DOI 10.1111/1742-6723.13873
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5940: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Impacts of Aging on Anemia Tolerance, Transfusion Thresholds, and Patient Blood Management.

    Simon, Geoff I / Craswell, Alison / Thom, Ogilvie / Chew, Michelle S / Anstey, Chris M / Fung, Yoke Lin

    Transfusion medicine reviews

    2019  Volume 33, Issue 3, Page(s) 154–161

    Abstract: Evidence-based patient blood management guidelines commonly recommend restrictive hemoglobin thresholds of 70 to 80 g/L for asymptomatic adults. However, most transfusion trials have enrolled adults across a broad age span, with few exclusive to older ... ...

    Abstract Evidence-based patient blood management guidelines commonly recommend restrictive hemoglobin thresholds of 70 to 80 g/L for asymptomatic adults. However, most transfusion trials have enrolled adults across a broad age span, with few exclusive to older adults. Our recent meta-analysis of transfusion trials that focused on older adults paradoxically found lower mortality and fewer cardiac complications when these patients were managed using higher hemoglobin thresholds. We postulate that declining cardiac output with age contributes to deteriorating oxygen delivery capacity which impacts anemia-associated outcomes in older adults and propose a model to explain this age-related difference. We reviewed evidence concerning the pathophysiology of aging to explore the disparity in transfusion trial outcomes related to hemoglobin thresholds in different age groups. The literature was searched for normative cardiac output values at different ages in healthy adults. Using normative peak cardiac output data, we modeled oxygen delivery capacity in young, middle-aged, and older adults at a range of hemoglobin levels. Cardiovascular and pulmonary systems are impacted by age-related pathophysiological changes. Diminishing peak cardiac output associated with aging reduces the maximal oxygen delivery achievable under metabolic stress. Hence, at low hemoglobin levels, older adults are more susceptible to tissue hypoxia than younger adults. Our model predicts that an older adult with a hemoglobin of 100 g/L has a similar peak oxygen delivery capacity to a young adult with a hemoglobin of 70 g/L. Age-related pathophysiological changes provide some explanation as to why older adults have a lower tolerance for anemia than younger adults. This indicates the need for patient blood management hemoglobin thresholds specific to older as distinct from younger adults. The primary application of this model is in the consideration of patients rehabilitating to life outside hospital. It is important to note that pathophysiological changes associated with critical illness and major surgery are more complex than can be described in a simple model based on cardiac output and hemoglobin concentration. However, our review of oxygen transport and delivery in health and disease states allows the model to be considered in the context of treatment decisions for anemic adults in a range of hospital and community settings.
    MeSH term(s) Aged ; Aged, 80 and over ; Aging/blood ; Aging/physiology ; Anemia/blood ; Anemia/etiology ; Anemia/physiopathology ; Anemia/prevention & control ; Biomarkers/blood ; Blood Transfusion/methods ; Cardiac Output/physiology ; Hemoglobins/metabolism ; Humans ; Hypoxia/blood ; Hypoxia/etiology ; Hypoxia/physiopathology ; Hypoxia/prevention & control ; Models, Biological ; Oxygen/blood ; Oxygen Consumption ; Transfusion Reaction/blood ; Transfusion Reaction/etiology ; Transfusion Reaction/physiopathology ; Transfusion Reaction/prevention & control
    Chemical Substances Biomarkers ; Hemoglobins ; Oxygen (S88TT14065)
    Language English
    Publishing date 2019-04-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 639107-2
    ISSN 1532-9496 ; 0887-7963
    ISSN (online) 1532-9496
    ISSN 0887-7963
    DOI 10.1016/j.tmrv.2019.03.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2239: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Outcomes of restrictive versus liberal transfusion strategies in older adults from nine randomised controlled trials: a systematic review and meta-analysis.

    Simon, Geoff I / Craswell, Alison / Thom, Ogilvie / Fung, Yoke Lin

    The Lancet. Haematology

    2017  Volume 4, Issue 10, Page(s) e465–e474

    Abstract: Background: Guidelines for patient blood management recommend restrictive transfusion practice for most adult patients. These guidelines are supported by evidence from randomised controlled trials (RCTs); however, one of the patient groups not ... ...

    Abstract Background: Guidelines for patient blood management recommend restrictive transfusion practice for most adult patients. These guidelines are supported by evidence from randomised controlled trials (RCTs); however, one of the patient groups not explicitly examined in these studies is the geriatric population. We examined RCTs relevant to transfusion outcomes in older patients. Our aim was to determine whether special guidelines are warranted for geriatric patients, recognising the different pathophysiological characteristics of this group.
    Methods: For this systematic review and meta-analysis, we searched PubMed, Scopus, and the Cochrane Library databases from their inception to May 5, 2017, for evidence relating to transfusion outcomes in adults aged 65 years and older. This criterion was widened to include RCTs where a substantial proportion of the study population was older than 65 years. We also included study populations of all clinical settings, and did not limit the search by date, language, or study type. For articles not in English, only available translations of the abstracts were reviewed. Studies were excluded if they did not specify age. Observational studies and duplicate patient and outcome data from studies that generated multiple publications were also excluded. We screened bibliographies of retrieved articles for additional publications. We analysed data extracted from published RCTs comparing restrictive and liberal transfusion strategies in older adults. We generated fixed effects risk ratios (RR) for pooled study data using the Mantel-Haenszel method. Primary outcomes were 30-day and 90-day mortality events for patients enrolled in restrictive and liberal transfusion study groups. We included intention-to-treat outcome data in the meta-analysis when available, otherwise we used per-protocol outcome data.
    Findings: 686 articles were identified by the search, and a further 37 by the snowball approach. Of these articles, 13 eligible papers described findings from nine RCTs (five trials investigating orthopaedic surgery, three cardiac surgery, and one oncology surgery; including 5780 patients). The risk of 30-day mortality was higher in older patients who followed a restrictive transfusion strategy than in those who followed a liberal transfusion strategy (risk ratio [RR] 1·36, 95% CI 1·05-1·74; p=0·017). The risk of 90-day mortality was also higher in those who followed a restrictive transfusion strategy than in those who followed a liberal transfusion strategy (RR 1·45, 95% CI 1·05-1·98; p=0·022).
    Interpretation: Liberal transfusion strategies might produce better outcomes in geriatric patients than restrictive transfusion strategies. This outcome contradicts current restrictive transfusion approaches. Population ageing will challenge resources globally, and this finding has implications for blood supply and demand, and optimal care of older adults. Further research is needed to formulate evidence-based transfusion practice across clinical specialties specific to the geriatric population, and to examine resource effects.
    Funding: Australia's National Blood Authority.
    MeSH term(s) Age Factors ; Blood Transfusion/methods ; Blood Transfusion/standards ; Humans ; Length of Stay ; Outcome Assessment (Health Care) ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2017-09-11
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Review
    ISSN 2352-3026
    ISSN (online) 2352-3026
    DOI 10.1016/S2352-3026(17)30141-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Authors' reply to comment Blood transfusion strategies in elderly patients.

    Simon, Geoff I / Craswell, Alison / Thom, Ogilvie / Fung, Yoke Lin

    The Lancet. Haematology

    2017  Volume 4, Issue 11, Page(s) e508

    MeSH term(s) Aged ; Blood Transfusion ; Humans
    Language English
    Publishing date 2017-09-11
    Publishing country England
    Document type Letter ; Comment
    ISSN 2352-3026
    ISSN (online) 2352-3026
    DOI 10.1016/S2352-3026(17)30172-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

    Inter-library loan at ZB MED

    Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

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