Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts

Montoro, Miguel; Cucala, Mercedes; Lanas, Fernando; Villanueva, Carmen Navarro; Hervás, Antonio; Alcedo, Javier; Gisbert, Javier P.; Aísa, Ángeles Pérez; Bujanda, Luís; Calvet, Xavier; Mearin, Fermı́n; Murcia, Óscar; Canelles, P; López, Santiago García; Argila, Carlos Martín de; Planella, Montserrat; Quintana, Manuel; Jericó, Carlos Rilova; Erce, José Antonio García

doi:10.3389/fmed.2022.903739

Cited by 8 publications

(4 citation statements)

References 116 publications

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“…El tratamiento de la anemia debe ser: etiológico (de la causa de base), etiopatogénico (según el tipo de anemia, Fe, vitaminas, EPO, etc. ), y la transfusión debe limitarse no a tratar una cifra, sino a tratar unos signos o síntomas de hipoxia, o disfunción orgánica, o para llevar el nivel de Hb a un valor de seguridad, que dependerá de la velocidad de instauración y de su tolerancia 12 . Este tratamiento se realiza con componentes sanguíneos sin tener en cuenta el estado hemodinámico u otros factores tal y como indican las recomendaciones Do Not To Do de la Sociedad Americana de Hematología 13 , evidenciando la poca adecuación del tratamiento transfusional en los SUH, tal como también indican los estudios de Quintana et al 14 .…”

Section: Discussionunclassified

Epidemiologic and clinical profile of anemia in a hospital emergency department

López Riquelme,

Álvarez Rodríguez,

González González

et al. 2024

Rev Esp Urg Emerg

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INTRODUCCIÓN. La anemia empeora el pronóstico de aquellos pacientes que acuden a los servicios de urgencia hospitalarios (SUH) y presentan comorbilidades como cardiopatía, enfermedad renal crónica (ERC), enfermedad oncológica (EO) o edad avanzada. A día de hoy, no disponemos de suficientes estudios que describan el perfil clínico de los pacientes con anemia en los SUH. OBJETIVO. Conocer las características de los pacientes y el manejo clínico de la anemia en un SUH. METODOLOGÍA. Estudio descriptivo observacional de serie de casos con análisis transversal de características clínicas y manejo de pacientes anémicos que acudieron al SUH entre el 1 de noviembre de 2015 y el 28 de febrero de 2016. RESULTADOS. Se incluyeron 376 pacientes con anemia (prevalencia 2,6%), con una edad media de 76 años (53,2% mujeres). La mayoría de anemias eran leves (79,1%) y de causa nutricional (73,7%). Los pacientes asociaban frecuentemente patologías graves tales como: EO (29,5%), cardiopatías como fibrilación auricular (FA; 24,7%) e insuficiencia cardiaca (IC; 22,1%) y ERC (19,9%). El 23,9% presentaba antecedentes de anemia previa y el 60,1% tomaba antiagregantes o anticoagulantes. Un 28,2% acudió por síntomas de anemia, siendo la astenia el más frecuente (16,8%). Se incluyó el diagnóstico de anemia en un 23,5% de las historias, siendo los únicos factores que contribuyen a ello, presentar anemia como antecedente o tener hemoglobina (Hb) menor de 8 g/dl (p < 0,001). Se trató al 11,6% de los pacientes, siendo la transfusión hemática el método más utilizado (11,6%). La Hb menor de 8 g/dl, fue el único factor decisorio en la administración de tratamiento (p < 0,001). CONCLUSIONES. La anemia es frecuente en los SUH es en la mayoría de casos nutricional y leve. Frecuentemente se asocia a IC, FA, EO, ERC y toma de antiagregantes y anticoagulantes. El diagnóstico y tratamiento se realiza en una baja proporción de pacientes. Existe una oportunidad de mejora en el manejo de la anemia en los SUH, que podría redundar positivamente en el pronóstico del paciente pluripatológico.

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Section: Discussionunclassified

Epidemiologic and clinical profile of anemia in a hospital emergency department

López Riquelme,

Álvarez Rodríguez,

González González

et al. 2024

Rev Esp Urg Emerg

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“…On the other hand, determining a transfusion Hb threshold level for life support in palliative care is even more difficult. There was a recommendation that RBC transfusions should be considered for patients with Hb levels of less than 5 g/dL for the management of chronic anaemia owing to occult blood loss [22]; however, the threshold should be carefully determined depending on the patient's background.…”

Section: Discussionmentioning

confidence: 99%

Home transfusions are implemented using diverse approaches in Japan

Tanaka,

Fujita,

Ohashi

et al. 2023

Vox Sanguinis

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Background and ObjectivesJapan's ageing society has increased the need for home healthcare, including home transfusions. We hence aimed to elucidate the purpose and utilization of home transfusions in Japan, which has not been clarified to date.Materials and MethodsClinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The study period was February to December 2019, and information of patients receiving home red blood cell transfusions, including patient background, pre‐transfusion laboratory data and the purpose of the transfusions, was collected.ResultsHaematological malignancies and solid tumours accounted for 70% of the patients' underlying diseases, with the former being significantly more common in urban areas. Regarding the purpose of the home transfusions, haematologists focused on symptom improvement, whereas gastroenterology surgeons focused on life support. Furthermore, maintenance of life was more likely to be the aim in the group of patients with the lowest level of activities of daily living. The main items that were significantly associated with a low haemoglobin level before transfusion included age ≥90 years and a gastroenterologist being the physician in charge.ConclusionHome transfusions were found to be performed in a restrictive and diverse manner in Japan. Life support is the second most common purpose of home transfusion in Japan, and optimizing effective home transfusion remains a challenge.

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“…Consensus exists amongst the latest ACG, ESGE, and BSG society guidelines regarding indications for RBC transfusion in acute LGIB, with a recommended restrictive transfusion strategy, and a threshold hemoglobin level of 7 g/dl for initiating RBC transfusion. In cases of active ischemia (especially acute coronary syndrome) or a history of cardiovascular disease, a more liberal blood transfusion hemoglobin threshold of 8–9 g/dl is recommended [1 ▪▪ ,3,8,24].…”

Section: Patient Presentationmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding

Elimeleh,

Gralnek

2023

Current Opinion in Gastroenterology

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Purpose of review We review and summarize the most recent literature, including evidence-based guidelines, on the evaluation and management of acute lower gastrointestinal bleeding (LGIB). Recent findings LGIB primarily presents in the elderly, often on the background of comorbidities, and constitutes a significant healthcare and economic burden worldwide. Therefore, acute LGIB requires rapid evaluation, informed decision-making, and evidence-based management decisions. LGIB management involves withholding and possibly reversing precipitating medications and concurrently addressing risk factors, with definitive diagnosis and therapy for the source of bleeding usually performed by endoscopic or radiological means. Recent advancements in LGIB diagnosis and management, including risk stratification tools and novel endoscopic therapeutic techniques have improved LGIB management and patient outcomes. In recent years, the various society guidelines on acute lower gastrointestinal bleeding have been revised and updated accordingly. Summary By integrating the most recently published high-quality clinical studies and society guidelines, we provide clinicians with an up-to-date and comprehensive overview on acute LGIB diagnosis and management.

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Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts

Abstract: Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts.

Cited by 8 publications

References 116 publications

Epidemiologic and clinical profile of anemia in a hospital emergency department

Epidemiologic and clinical profile of anemia in a hospital emergency department

Home transfusions are implemented using diverse approaches in Japan

Diagnosis and management of acute lower gastrointestinal bleeding

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