Advances in transfusion medicine: gastrointestinal bleeding

Abstract

Gastrointestinal bleeding is a common medical and surgical emergency and is the second most common indication for red blood cell (RBC) transfusion in the UK. Most transfusion guidelines recommend the use of restrictive blood transfusion in stable gastrointestinal bleeding. This review explores the evidence supporting this practice, including whether it is safe in lower as well as upper gastrointestinal bleeding, and the risks of restrictive transfusion in patients with cardiovascular disease. There is a lack of evidence supporting the use of platelet and fresh frozen plasma transfusion in gastrointestinal bleeding. The aim of this review is to serve as a practical guide to transfusion in stable gastrointestinal bleeding.

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

“…In UGIB two recent RCTs compared restrictive and liberal RBC transfusion 96. One demonstrated increased 6-week survival and reduced rebleeding with a restrictive transfusion policy, although this effect was most notable in patients with cirrhosis and variceal bleeding 97.…”

The effect of red‐blood‐cell transfusion on fatigue in hospitalized patients with anaemia

“…The age categories were determined by dividing the sample into near tertiles based on age. Patients with SC and/or GIB were excluded from primary analysis because transfusion guidelines exclude patients with SC from their recommendations (chronic transfusion dependent anemia)[4], and standard clinical transfusion practices in patients with SC[27, 28] and/or GIB[29, 30] do not follow restrictive transfusion practices. Additionally, transfusion practices at our institution vary significantly for patients with GIB compared to patients without a GIB, and by the location of GIB.…”

Clinical experience with ferric carboxymaltose in the management of anemia in acute gastrointestinal bleeding

“…Moreover, it is associated with an increased risk for rebleeding and higher mortality 9,11. Restricted use of blood transfusion, whereby it is administered only to patients with very low hemoglobin (Hb) levels, has become the standard of care in many types of AGIB 12. European and US guidelines recommend a restrictive transfusion strategy that targets a Hb level between 7 and 9 g/dl or higher Hb target levels if the patient has intravascular volume depletion or significant comorbidity such as ischemic cardiovascular disease 13,14.…”