Blood transfusion in elderly patients with chronic anemia: a qualitative analysis of the general practitioners’ attitudes

Sylvain Le Calvé, Dominique Somme, Joaquim Prud’homm, Aline Corvol

Blood transfusion in chronic anemia is not covered by guidelines specific to older adults. When they consider that this treatment is necessary in elderly patients, French general practitioners (GPs) contact a hospital specialist to plan a transfusion. Twenty French GPs were questioned individually regarding their approach to blood transfusion using semi-structured interviews. Each interview was recorded, typed up verbatim and then coded using an inductive procedure by theme, in a cross-over design (two researchers) in two phases: analysis and summary, followed by grouping of the recorded comments. The criteria for transfusion were hemoglobin level < 8 g/dL and cardiac comorbidities. Some geriatric issues, such as cognitive disorder or dependence, were considered, either as aspects of frailty favoring transfusion or as markers of reduced life expectancy that limit care. Falls and fear of an unpleasant death from anemia prompted GPs to order blood transfusion. The patient's family provided guidance, but the patient was not routinely consulted. The specialists were rarely asked to participate in decision making. GPs' perceptions were ambivalent: they considered transfusion to be extraordinary and magical, but also pointless since its effects are transient. The decision to give a transfusion to an elderly patient with chronic anemia is deemed complex, but GPs seem to take it alone, sometimes guided by the patient's family. The drawing up of an advance care plan could help involve the patient in decision making.