The implementation of a geriatric patients blood management program to monitor hemoglobin level in nursing homes| JOURNAL OF GERONTOLOGY AND GERIATRICS

Abstract

Background and Aims. In reference to the Resolution WHA63.12 of 21/05/2010 from the World Health Organization, the Italian National Blood Center has promoted an initiative encapsulated by the term Patient
Blood Management (PBM). The aim of this study is to examine the relationships among the prevalence of
genera-age-associated risk factors of anemia and hemoglobin level in geriatric patients with cognitive decline
through CBA SIPCARplus software (medical records). Before this implementation, there was not the traditional
blood management program in nursing homes.
Methods. The CBA database has been developed by a dedicated working group using Delphi process and
PBM. It contains records on patient characteristics, and one set of biomarker laboratory.
Results. Between 2014 and 2015, 283 geriatric patients were enrolled at three Italian elderly nursing homes.
Among these patients, 14% were men and 86% were women (mean age 79 years) and the overall prevalence of
anemia was 55.9%; 32.6% of the geriatric patients were at risk of malnutrition and 11.5% were malnourished.
Multivariate analysis determined that comorbidity was highly associated with malnutrition risk measured by
Malnutrition Universal Screening Tool ≥ 2, cognitive decline measured by Mini-mental State Examination ≤ 19,
functional independence in two or more basic activities of daily living, Hgb level of 69 g/L (p = 0.01) and Hgb
level of 100 g/L (p = 0.02). Two variables were significantly associated with an increase of the transfusion
threshold above 90 g/L: the poor tolerance of anemia (p = 0.001) and clinical risk situations (p = 0.03).
Conclusions. The appropriateness of results could be useful to better describe the role of PBM with CBA and
biomarkers recorded in geriatric practice, transfusion thresholds, target hemoglobin levels after transfusion.