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Étude des modifications échocardiographiques avant et après la transfusion d’un culot de globules rouges chez les patients de plus de 60 ans en structure d’urgences : l’étude TRANS-US
Mémoire de Master / Thèse d'exercice   Open Access

Étude des modifications échocardiographiques avant et après la transfusion d’un culot de globules rouges chez les patients de plus de 60 ans en structure d’urgences : l’étude TRANS-US

Charlotte Lacroix
Masters , Université de Montpellier
16/09/2024

Résumé

Red blood cell transfusion Emergency department Anémie -- Chez la personne âgée Transfusion sanguine Échocardiographie Oedème pulmonaire Urgences médicales Anemia Echocardiography Pulmonary edema
Anemia is a common health issue among the elderly and is associated with increased mortality in various pathologies. The first-line treatment for symptomatic anemia is the transfusion of red blood cell concentrates (RBC-T). However, elderly patients, who are often affected by multiple comorbidities, have a higher risk of adverse events following RBC-T, such as Transfusion-related acute cardiac overload (TACO), a transfusion-induced pulmonary edema. Method: this prospective, bicentric study evaluated the effect of RBC-T on hemodynamic parameters in patients over 60 years old in emergency department settings. The main objectives were to measure changes in the E/A ratio and other cardiac and pulmonary ultrasound parameters before and after RBC-T. Results: forty-seven patients were included in the interim analysis. The change in the E/A ratio was not significant after RBC-T (+2% [-13; 20] from T0 to T1; p=0.45 and +6 [-5; 20] from T0 to T2; p=0.19). The modified lung ultrasound score (mLUS) showed an increase (+0% [0; 69] between T0 and T1; p<0.001 and +17% [0; 100] between T0 and T2; p<0.001). Other parameters, such as the E/e’ ratio or the aortic velocity-time integral, did not show any significant changes. Discussion: the absence of variation in the E/A ratio could be due to the limited sample size. It is also possible that the E/A ratio is not the best indicator for anticipating post-transfusion complications. The mLUS might represent a useful tool for detecting complications related to volume overload. Conclusion: interim results indicate that RBC-T did not result in a change in the E/A ratio among patients over 60 years old in emergency settings. These findings will need to be validated once the cohort is complete.

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