Who is using blood and when-impact of the ageing population on demand for and urgency of transfusion

Abstract

Background: Previous studies report that patients aged 65 years and above consume 50% or more of the blood supply. It has been reported that growth in the older population will place pressure on blood supplies. Key Patient Blood Management (PBM) strategies include optimisation of patient's physiology prior to interventions that may require transfusion support. Patients transfused soon after Emergency Department (ED) presentation are more likely to have deranged physiology, with limited or no opportunity for optimisation of anaemia status, or modification of anticoagulant medications. This challenges PBM based approaches to blood management. In addition, our recent review of evidence relating to transfusion outcomes in older adults identified that liberal rather than restrictive transfusion strategies may have better outcomes in this cohort. This has implications for overall red cell use. Aims: To explore blood use in older patients, with a focus on ED presentations. Blood use was stratified by age, gender, urgency and indication to gain insight into rates and reasons for transfusion in the older population. We sought to understand blood use in the context of regional population demographics. Methods: Data was obtained for 5,294 blood products transfused over a 12-month period in an Australian regional health and hospital service. Blood data was linked to 85,014 ED presentations. The age and gender of each recipient was obtained via linkage to the hospitals' patient admissions systems. The number of blood products transfused within 24 h of ED presentation was quantified, and separated from non- ED related blood use. The patient admission and ED information systems were interrogated to obtain information including the reasons for presentation and discharge diagnoses. Overall population analysis was undertaken to identify ageing trends in the region under study. Results: The proportion of the population aged 65 years and above in the study region was 19.8%, which is 30% higher than the Australian national average. The rate of ED presentations per 1,000 population increased significantly with age, with higher rates for older males than females. Sixty percent of all blood products were transfused to patients aged 65 years and above, which is higher than reported in other studies. The pattern of red cell use per 1,000 population stratified by age mirrored data published for England and North Wales. 28% of blood products were transfused to patients within 24 h of ED presentation, indicating a significant level of unplanned transfusion. For those aged 65 years and above, females consumed three-fold and males greater than five-fold more red cells per 1,000 ED presentations than patients below 65 years of age. Summary/Conclusions: In this study, blood consumption by those aged 65 years and above is higher than previously reported, and strongly skewed towards males. In the context of an ageing population and with male life expectancy increasing relative to female, these findings have significant implications for future supply and demand.L616935892