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Blood transfusion practices in upper gastrointestinal bleeding: response to a landmark study
  1. Cameron B Wilhoit,
  2. Nathan D Holman,
  3. Don C Rockey
  1. Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Don C Rockey, Internal Medicine, Medical University of South Carolina, Charelston, SC 29425, USA; rockey{at}musc.edu

Abstract

Objective Lack of clear evidence in red blood cell (RBC) transfusion during gastrointestinal bleeding has led to varied recommendations over the years. However, studies in broad areas of medicine have provided evidence about appropriate RBC transfusion thresholds, and a ‘landmark’ study published in 2013 provided evidence in patients with upper gastrointestinal (UGI) bleeding. We hypothesized that the response to the evidence would lead to improved RBC transfusion practice. Our aim was to determine the response in RBC transfusion practices at our institution.

Design We examined RBC transfusion practices in patients with UGI bleeding who presented to the Medical University of South Carolina from January 2010 through December 2013. We abstracted extensive clinical data including demographic, medical history (comorbidities), medications, physical examination findings, laboratory data, endoscopic data, and RBC transfusion practices. We considered appropriate RBC transfusion to have occurred when performed for a hemoglobin level of <70 g/L.

Results 270 patients hospitalized with UGI bleeding had 606 RBC transfusions; 355 transfusions in 107 patients were appropriate, and 251 transfusions in 163 were inappropriate. In 2010, 2011, and 2012, the rates of appropriate RBC transfusions were 61/124 (49%), 92/172 (53%), and 84/142 (59%), respectively. There was a statistically significant difference in appropriate transfusions in 2013 (118/168 (70%)) compared with 2012 (84/142 (59%), p=0.003), as well as during 2010–2012 (237/438 (54%), p≤0.003).

Conclusions The data suggest that there was an improvement in RBC transfusion practices after a landmark study. However, the data also highlight that RBC transfusion practices in UGI bleeding remain imperfect.

  • gastrointestinal hemorrhage
  • peptic ulcer
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Footnotes

  • Contributors CBW and NDH: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript and critical revision of the manuscript for important intellectual content. DR: study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and supervisory activities.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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