The Influence of Older Age on RBC Transfusion Decisions in ICU Patients

Area of Science:

• Critical Care Medicine
• Hematology
• Geriatrics

Background:

• Red blood cell (RBC) transfusions are a common intervention in intensive care units (ICUs).
• Emerging evidence suggests restrictive transfusion policies may be as effective or superior to liberal approaches.
• The specific impact of patient age on RBC transfusion practices remains underexplored, despite potential age-related physiological differences.

Purpose of the Study:

• To investigate whether RBC transfusion practices vary among adult ICU patients across different age groups.
• To explore the influence of age on transfusion thresholds and stated reasons for transfusion.

Main Methods:

• A substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort.
• Data collected from 233 ICUs across 30 countries between March 2019 and October 2022.
• Adult ICU patients categorized into age groups: <65, 65-75, 75-85, and >85 years.

Main Results:

• A total of 3643 patients were analyzed, with 4% being older than 85 years.
• RBC transfusion rates were similar across age groups (23-26%, p=0.91).
• Patients >85 years had higher median hemoglobin thresholds (10.0 g/dL vs. 8.0 g/dL, p<0.001) and cited 'age' and 'improve general state' more often as reasons for transfusion.

Conclusions:

• While specific transfusion thresholds and stated reasons differ for very elderly patients (>85 years), age itself is not independently associated with receiving an RBC transfusion.
• Observed differences in transfusion strategies for older patients appear linked to age-related physiological changes and diagnoses, not age as a sole motivator.