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

Caroline M. Schaap; Senta Jorinde Raasveld; Florian Reizine; Boillot Corentin; Jimmy Schenk; Sanne de Bruin; Merijn C. Reuland; Claudia van den Oord; Andrew W.J. Flint; Tarikul Hamid; Michaël Piagnerelli; Tina Tomić Mahečić; Jan Benes; Lene Russell; Hernán Marcelo Aguirre Bermeo; Konstantina Triantafyllopoulou; Vasiliki Chantziara; Mohan Gurjar; Sheila Nainan Myatra; Vincenzo Pota; Muhammed Elhadi; Ryszard Gawda; Mafalda Mourisco; Marcus Lance; Vojislava Neskovic; Matej Podbregar; Juan V. Llau; Manual Quintana Díaz; Maria Cronhjort; Carmen A. Pfortmueller; Nihan Yapici; Nathan Nielsen; Akshay Shah; Jan Bakker; Maurizio Cecconi; Aarne Feldheiser; Jens Meier; Zoe McQuilten; Marcella C.A. Müller; Thomas W.L. Scheeren; Cécile Aubron; Alexander P.J. Vlaar; Harm Jan de Grooth

doi:10.1097/CCM.0000000000007131

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

Caroline M. Schaap (First Author)
, Senta Jorinde Raasveld
, Florian Reizine
, Boillot Corentin
, Jimmy Schenk
, Sanne de Bruin
, Merijn C. Reuland
, Claudia van den Oord
, Andrew W.J. Flint
, Tarikul Hamid
, Michaël Piagnerelli
, Tina Tomić Mahečić
, Jan Benes
, Lene Russell
, Hernán Marcelo Aguirre Bermeo
, Konstantina Triantafyllopoulou
, Vasiliki Chantziara
, Mohan Gurjar
, Sheila Nainan Myatra
, Vincenzo Pota

Muhammed Elhadi, Ryszard Gawda, Mafalda Mourisco, Marcus Lance, Vojislava Neskovic, Matej Podbregar, Juan V. Llau, Manual Quintana Díaz, Maria Cronhjort, Carmen A. Pfortmueller, Nihan Yapici, Nathan Nielsen, Akshay Shah, Jan Bakker, Maurizio Cecconi, Aarne Feldheiser, Jens Meier, Zoe McQuilten, Marcella C.A. Müller, Thomas W.L. Scheeren, Cécile Aubron, Alexander P.J. Vlaar, Harm Jan de Grooth (Last Author)

Academic Medical Center of University of Amsterdam
CH de Vannes
Université de Bretagne Occidentale
Amsterdam UMC
Monash University
Asgar Ali Hospital
Université libre de Bruxelles
University of Zagreb
Charles University
University of Copenhagen
Hospital Vicente Corral Moscoso
Interbalkan Medical Center
National and Kapodistrian University of Athens
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Tata Memorial Hospital
University of Campania Luigi Vanvitelli
University of Tripoli
University of Opole
Centro Hospitalar de Entro o Douro e Vouga
Aga Khan University
Military Medical Academy
University of Ljubljana
Hospital Universitario Dr. Peset
Hospital Universitario La Paz
Karolinska Institutet
University of Bern
University of Health Sciences
University of New Mexico
University of Oxford
New York University
Erasmus University Rotterdam
Pontificia Universidad Católica de Chile
IRCCS Istituto Clinico Humanitas - Rozzano (Milano)
Kliniken Essen-Mitte
Johannes Kepler University Linz
University of Groningen
Utrecht University

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: – RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in transfusion. In elderly ICU patients, reduced physiologic reserves may shift the perceived risk-benefit balance of transfusion, potentially leading to different transfusion practices. This study examines whether transfusion practices in ICU patients differ across patient age. Design: – This is a substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort study. Setting: – ICUs from 233 centers across 30 countries. Data were collected from March 2019 to October 2022 in prespecified weeks. Patients: – Adult ICU patients (≥ 18 yr) admitted during predefined study weeks. Patients were categorized by age (< 65, 65–75, 75–85, and > 85 yr). Interventions: – None. Measurements and Main Results: – A total of 3643 patients from 233 centers across 30 countries were included. Of these, 53% were younger than 65 years, 26% were 65–75 years, 17% were 75–85 years, and 4% were older than 85 years. RBC transfusion rates ranged from 23% to 26% across all age groups (p = 0.91). Patients older than 85 years had higher stated hemoglobin thresholds (median, 10.0 g/dL) compared with younger patients (median, 8.0 g/dL; p < 0.001). “Age” and “improve general state” were more frequently cited as reasons for transfusion in patients older than 85 years. However, after adjustment, age was not associated with the probability of receiving an RBC transfusion. Conclusions: – Different transfusion strategies are applied in patients older than 85 years old. These differences appear to be driven by age-related differences in physiology and diagnoses rather than motivated by older age itself.

Original language	English
Pages (from-to)	1-13
Number of pages	13
Journal	Critical Care Medicine
Volume	54
DOIs	https://doi.org/10.1097/CCM.0000000000007131
State	Published - 8 Apr 2026
Externally published	Yes

Keywords

elderly
intensive care unit
red blood cell
transfusion

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10.1097/CCM.0000000000007131License: CC BY-NC-ND

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Schaap, C. M., Raasveld, S. J., Reizine, F., Corentin, B., Schenk, J., de Bruin, S., Reuland, M. C., van den Oord, C., Flint, A. W. J., Hamid, T., Piagnerelli, M., Mahečić, T. T., Benes, J., Russell, L., Aguirre Bermeo, H. M., Triantafyllopoulou, K., Chantziara, V., Gurjar, M., Myatra, S. N., ... Grooth, H. J. D. (2026). The Influence of Older Age on RBC Transfusion Decisions in ICU Patients. Critical Care Medicine, 54, 1-13. https://doi.org/10.1097/CCM.0000000000007131

@article{62353de12efa4482a06326ede74f964a,

title = "The Influence of Older Age on RBC Transfusion Decisions in ICU Patients",

abstract = "Objectives: – RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in transfusion. In elderly ICU patients, reduced physiologic reserves may shift the perceived risk-benefit balance of transfusion, potentially leading to different transfusion practices. This study examines whether transfusion practices in ICU patients differ across patient age. Design: – This is a substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort study. Setting: – ICUs from 233 centers across 30 countries. Data were collected from March 2019 to October 2022 in prespecified weeks. Patients: – Adult ICU patients (≥ 18 yr) admitted during predefined study weeks. Patients were categorized by age (< 65, 65–75, 75–85, and > 85 yr). Interventions: – None. Measurements and Main Results: – A total of 3643 patients from 233 centers across 30 countries were included. Of these, 53\% were younger than 65 years, 26\% were 65–75 years, 17\% were 75–85 years, and 4\% were older than 85 years. RBC transfusion rates ranged from 23\% to 26\% across all age groups (p = 0.91). Patients older than 85 years had higher stated hemoglobin thresholds (median, 10.0 g/dL) compared with younger patients (median, 8.0 g/dL; p < 0.001). “Age” and “improve general state” were more frequently cited as reasons for transfusion in patients older than 85 years. However, after adjustment, age was not associated with the probability of receiving an RBC transfusion. Conclusions: – Different transfusion strategies are applied in patients older than 85 years old. These differences appear to be driven by age-related differences in physiology and diagnoses rather than motivated by older age itself.",

keywords = "elderly, intensive care unit, red blood cell, transfusion, Elderly, Intensive care unit, Red blood cell, Transfusion",

author = "Schaap, \{Caroline M.\} and Raasveld, \{Senta Jorinde\} and Florian Reizine and Boillot Corentin and Jimmy Schenk and \{de Bruin\}, Sanne and Reuland, \{Merijn C.\} and \{van den Oord\}, Claudia and Flint, \{Andrew W.J.\} and Tarikul Hamid and Micha{\"e}l Piagnerelli and Mahe{\v c}i{\'c}, \{Tina Tomi{\'c}\} and Jan Benes and Lene Russell and \{Aguirre Bermeo\}, \{Hern{\'a}n Marcelo\} and Konstantina Triantafyllopoulou and Vasiliki Chantziara and Mohan Gurjar and Myatra, \{Sheila Nainan\} and Vincenzo Pota and Muhammed Elhadi and Ryszard Gawda and Mafalda Mourisco and Marcus Lance and Vojislava Neskovic and Matej Podbregar and Llau, \{Juan V.\} and \{Quintana D{\'i}az\}, Manual and Maria Cronhjort and Pfortmueller, \{Carmen A.\} and Nihan Yapici and Nathan Nielsen and Akshay Shah and Jan Bakker and Maurizio Cecconi and Aarne Feldheiser and Jens Meier and Zoe McQuilten and M{\"u}ller, \{Marcella C.A.\} and Scheeren, \{Thomas W.L.\} and C{\'e}cile Aubron and Vlaar, \{Alexander P.J.\} and Grooth, \{Harm Jan de\}",

note = "Publisher Copyright: Copyright {\textcopyright} 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.",

year = "2026",

month = apr,

day = "8",

doi = "10.1097/CCM.0000000000007131",

language = "Ingl{\'e}s",

volume = "54",

pages = "1--13",

journal = "Critical Care Medicine",

issn = "0090-3493",

}

Schaap, CM, Raasveld, SJ, Reizine, F, Corentin, B, Schenk, J, de Bruin, S, Reuland, MC, van den Oord, C, Flint, AWJ, Hamid, T, Piagnerelli, M, Mahečić, TT, Benes, J, Russell, L, Aguirre Bermeo, HM, Triantafyllopoulou, K, Chantziara, V, Gurjar, M, Myatra, SN, Pota, V, Elhadi, M, Gawda, R, Mourisco, M, Lance, M, Neskovic, V, Podbregar, M, Llau, JV, Quintana Díaz, M, Cronhjort, M, Pfortmueller, CA, Yapici, N, Nielsen, N, Shah, A, Bakker, J, Cecconi, M, Feldheiser, A, Meier, J, McQuilten, Z, Müller, MCA, Scheeren, TWL, Aubron, C, Vlaar, APJ & Grooth, HJD 2026, 'The Influence of Older Age on RBC Transfusion Decisions in ICU Patients', Critical Care Medicine, vol. 54, pp. 1-13. https://doi.org/10.1097/CCM.0000000000007131

TY - JOUR

T1 - The Influence of Older Age on RBC Transfusion Decisions in ICU Patients

AU - Schaap, Caroline M.

AU - Raasveld, Senta Jorinde

AU - Reizine, Florian

AU - Corentin, Boillot

AU - Schenk, Jimmy

AU - de Bruin, Sanne

AU - Reuland, Merijn C.

AU - van den Oord, Claudia

AU - Flint, Andrew W.J.

AU - Hamid, Tarikul

AU - Piagnerelli, Michaël

AU - Mahečić, Tina Tomić

AU - Benes, Jan

AU - Russell, Lene

AU - Aguirre Bermeo, Hernán Marcelo

AU - Triantafyllopoulou, Konstantina

AU - Chantziara, Vasiliki

AU - Gurjar, Mohan

AU - Myatra, Sheila Nainan

AU - Pota, Vincenzo

AU - Elhadi, Muhammed

AU - Gawda, Ryszard

AU - Mourisco, Mafalda

AU - Lance, Marcus

AU - Neskovic, Vojislava

AU - Podbregar, Matej

AU - Llau, Juan V.

AU - Quintana Díaz, Manual

AU - Cronhjort, Maria

AU - Pfortmueller, Carmen A.

AU - Yapici, Nihan

AU - Nielsen, Nathan

AU - Shah, Akshay

AU - Bakker, Jan

AU - Cecconi, Maurizio

AU - Feldheiser, Aarne

AU - Meier, Jens

AU - McQuilten, Zoe

AU - Müller, Marcella C.A.

AU - Scheeren, Thomas W.L.

AU - Aubron, Cécile

AU - Vlaar, Alexander P.J.

AU - Grooth, Harm Jan de

PY - 2026/4/8

Y1 - 2026/4/8

N2 - Objectives: – RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in transfusion. In elderly ICU patients, reduced physiologic reserves may shift the perceived risk-benefit balance of transfusion, potentially leading to different transfusion practices. This study examines whether transfusion practices in ICU patients differ across patient age. Design: – This is a substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort study. Setting: – ICUs from 233 centers across 30 countries. Data were collected from March 2019 to October 2022 in prespecified weeks. Patients: – Adult ICU patients (≥ 18 yr) admitted during predefined study weeks. Patients were categorized by age (< 65, 65–75, 75–85, and > 85 yr). Interventions: – None. Measurements and Main Results: – A total of 3643 patients from 233 centers across 30 countries were included. Of these, 53% were younger than 65 years, 26% were 65–75 years, 17% were 75–85 years, and 4% were older than 85 years. RBC transfusion rates ranged from 23% to 26% across all age groups (p = 0.91). Patients older than 85 years had higher stated hemoglobin thresholds (median, 10.0 g/dL) compared with younger patients (median, 8.0 g/dL; p < 0.001). “Age” and “improve general state” were more frequently cited as reasons for transfusion in patients older than 85 years. However, after adjustment, age was not associated with the probability of receiving an RBC transfusion. Conclusions: – Different transfusion strategies are applied in patients older than 85 years old. These differences appear to be driven by age-related differences in physiology and diagnoses rather than motivated by older age itself.

AB - Objectives: – RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in transfusion. In elderly ICU patients, reduced physiologic reserves may shift the perceived risk-benefit balance of transfusion, potentially leading to different transfusion practices. This study examines whether transfusion practices in ICU patients differ across patient age. Design: – This is a substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort study. Setting: – ICUs from 233 centers across 30 countries. Data were collected from March 2019 to October 2022 in prespecified weeks. Patients: – Adult ICU patients (≥ 18 yr) admitted during predefined study weeks. Patients were categorized by age (< 65, 65–75, 75–85, and > 85 yr). Interventions: – None. Measurements and Main Results: – A total of 3643 patients from 233 centers across 30 countries were included. Of these, 53% were younger than 65 years, 26% were 65–75 years, 17% were 75–85 years, and 4% were older than 85 years. RBC transfusion rates ranged from 23% to 26% across all age groups (p = 0.91). Patients older than 85 years had higher stated hemoglobin thresholds (median, 10.0 g/dL) compared with younger patients (median, 8.0 g/dL; p < 0.001). “Age” and “improve general state” were more frequently cited as reasons for transfusion in patients older than 85 years. However, after adjustment, age was not associated with the probability of receiving an RBC transfusion. Conclusions: – Different transfusion strategies are applied in patients older than 85 years old. These differences appear to be driven by age-related differences in physiology and diagnoses rather than motivated by older age itself.

KW - elderly

KW - intensive care unit

KW - red blood cell

KW - transfusion

KW - Elderly

KW - Intensive care unit

KW - Red blood cell

KW - Transfusion

UR - https://www.scopus.com/pages/publications/105037177211

UR - https://www.mendeley.com/catalogue/ed3b279f-4383-39a6-aadb-3b7ff533413f/

UR - https://ecommons.aku.edu/eastafrica_fhs_mc_anaesth/80/

U2 - 10.1097/CCM.0000000000007131

DO - 10.1097/CCM.0000000000007131

M3 - Artículo

C2 - 41949385

AN - SCOPUS:105037177211

SN - 0090-3493

VL - 54

SP - 1

EP - 13

JO - Critical Care Medicine

JF - Critical Care Medicine

ER -

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

Abstract

Keywords

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