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Review
. 2025 Apr 30;37(1):135.
doi: 10.1007/s40520-025-03033-4.

Blood transfusion in older surgical patients: the only option or is there a better approach?

Mariagiovanna Cozza  1 , Virginia Boccardi  2 , Ruslan Duka  3 , Yogesh Vashist #  4 , Luigi Marano #  5   6   7   8
Affiliations
Review

Blood transfusion in older surgical patients: the only option or is there a better approach?

Mariagiovanna Cozza et al. Aging Clin Exp Res. .

Abstract

Anemia is a common clinical condition that can significantly affect patient outcomes, particularly in those undergoing surgery. In older adults, the presence of anemia combined with cardiovascular disease can increase surgical morbidity and mortality, influencing surgical decisions and creating a cascade of complications that may negatively impact recovery. Blood transfusion remains the primary response to anemia in the perioperative setting, despite evidence suggesting potential adverse effects on survival and recovery. However, older adults present unique challenges due to age-related physiological changes anda reduced tolerance to anemia and blood loss. The debate between restrictive and liberal blood transfusion strategies in this population remains unresolved. Patient Blood Management (PBM) protocols have been developed to systematically address perioperative anemia. This review emphasizes the need for a nuanced approach to transfusion in older adults, suggesting that while a restrictive strategy may not be universally applicable, decisions should be guided by thorough clinical evaluations. These assessments should prioritize not only hemoglobin levels but also patient-specific factors, including life expectancy, comorbidities, and patient preferences, with the involvement of a multidisciplinary team to tailor the best approach for everyone.

Keywords: Anemia; Blood transfusion; Geriatrics; Patient blood management; Perioperative care.

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Conflict of interest statement

Declarations. Assistance with the study: None. Financial support and sponsorship: None. Provenance and peer review: Not commissioned, externally peer-reviewed. Conflict of interest: None.

Figures

Fig. 1
Fig. 1
Anemia in older adults. This infographic illustrates the multifactorial aspects of perioperative anemia in aging patients, emphasizing its association with blood transfusion requirements. This figure underscores the importance of comprehensive anemia management in improving perioperative outcomes for older adults
Fig. 2
Fig. 2
Principles of Patient Blood Management (PBM) in older adults. This figure presents a comprehensive overview of PBM strategies tailored for older adults, focusing on three critical phases: pre-operative, intra-operative and post-operative management
See this image and copyright information in PMC

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