Anemia management and transfusion strategy in internal medicine units: Less is more

• Published in: European journal of internal medicine Vol. 115; pp. 48 - 54
• Main Authors: Blanca, Deborah, Parrella, Giorgio, Consonni, Dario, Villa, Stefania, Ceriani, Giuliana, Cespiati, Annalisa, Figini, Giovanni, Ghigliazza, Gabriele, Maira, Diletta, Oberti, Giovanna, Scaramellini, Natalia, Schinco, Giuseppina Luisa, Tafuri, Francesco, Montano, Nicola, Cappellini, Maria Domenica, Motta, Irene
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2023
• Subjects: Anemia management; Elderly hospitalized patients; Less is more; Transfusion strategy; Elderly hospitalized patients; Transfusion strategy; Anemia management; Less is more
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2023.05.022

•Anemia represents a significant health problem; its prevalence in elderly hospitalized patients in internal medicine and geriatric units reaches 60%.•Identifying the etiology of anemia is crucial to establish a proper treatment; however, only two-thirds of the patients undergo laboratory tests necessary to define the type of anemia.•The transfusion approach is highly heterogenous, reaching 30% of elderly hospitalized patients transfused in some cases. Education is a pillar in improving anemia diagnosis and management.•A more restrictive transfusional approach was comparable or superior to a more liberal one in terms of clinical outcomes (i.e., mortality, hemoglobin values at discharge and 30 days after discharge) and allowed to save RBC units. Blood transfusion is one of the most overused procedures, especially in elderly patients. Despite the current transfusion guidelines recommending a restrictive transfusion strategy in stable patients, the clinical practice varies according to physicians' experience and implementation of patient blood management. This study aimed to evaluate the anemia management and transfusion strategy in anemic elderly hospitalized and the impact of an educational program. We enrolled ≥ 65-year-old patients who presented or developed anemia during admission to a tertiary hospital's internal medicine and geriatric units. Patients with onco-hematological disorders, hemoglobinopathies and active bleeding were excluded. In the first phase, anemia management was monitored. In the second phase, the six participating units were divided into two groups and two arms: Educational (Edu) and non-educational (NE). During this phase, physicians in the Edu arm underwent an educational program for the appropriate use of transfusion and anemia management. In the third phase, anemia management was monitored. Comorbidities, demographic and hematological characteristics were similar in all phases and arms. The percentages of transfused patients during phase 1 were 27.7% in NE and 18.5% in the Edu arm. During phase 3, it decreased to 21.4% in the NE and 13.6% in the Edu arm. Hemoglobin levels at discharge and after 30 days were higher in the Edu group despite reduced use of blood transfusion. In conclusion, a more restrictive strategy was comparable or superior to the more liberal one in terms of clinical outcomes, with the advantage of saving red blood cell units and reducing related side effects. [Display omitted]