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Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists.

Fortinsky KJ, Martel M, Razik R, Spiegle G, Gallinger ZR, Grover SC, Pavenski K, Weizman AV, Kwapisz L, Mehta S, Gray S, Barkun AN - Can J Gastroenterol Hepatol (2016)

Bottom Line: Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L; p < 0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; p < 0.01) were transfused more liberally than healthy patients.Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.

ABSTRACT
Introduction. There is limited data evaluating physician transfusion practices in patients with acute upper gastrointestinal bleeding (UGIB). Methods. A web-based survey was sent to 500 gastroenterologists and hepatologists across Canada. The survey included clinical vignettes where physicians were asked to choose transfusion thresholds. Results. The response rate was 41% (N = 203). The reported hemoglobin (Hgb) transfusion trigger differed by up to 50 g/L. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean Hgb of 86.7 g/L versus 71.0 g/L; p < 0.001). Many clinicians (24%) reported transfusing a hemodynamically unstable patient at a Hgb threshold of 100 g/L and the majority (57%) are transfusing two units of RBCs as initial management. Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L; p < 0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; p < 0.01) were transfused more liberally than healthy patients. Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge. Conclusions. The transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB.

No MeSH data available.


Related in: MedlinePlus

Selected hemoglobin transfusion thresholds for a healthy and hemodynamically unstable patient with UGIB as described in Scenario  2.
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fig2: Selected hemoglobin transfusion thresholds for a healthy and hemodynamically unstable patient with UGIB as described in Scenario  2.

Mentions: For Scenario 1 (hemodynamically stable 50-year-old healthy patient with melena), 71% of clinicians transfused at hemoglobin (Hgb) below 70 (mean: 71.0 ± 6.4) and 29% deviated from current guidelines (Figure 1). If the same patient was hemodynamically unstable (Scenario 2), 69.3% of clinicians would provide a transfusion at Hgb below 90 (mean: 86.7 ± 11.8). The distribution of transfusion thresholds for the hemodynamically unstable patient varied by up to 60 g/L (range: 60 g/L to 120 g/L; see Figure 2). Transfusion thresholds for the two scenarios differed significantly (71.0 versus 86.7 g/L, p < 0.001).


Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists.

Fortinsky KJ, Martel M, Razik R, Spiegle G, Gallinger ZR, Grover SC, Pavenski K, Weizman AV, Kwapisz L, Mehta S, Gray S, Barkun AN - Can J Gastroenterol Hepatol (2016)

Selected hemoglobin transfusion thresholds for a healthy and hemodynamically unstable patient with UGIB as described in Scenario  2.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940523&req=5

fig2: Selected hemoglobin transfusion thresholds for a healthy and hemodynamically unstable patient with UGIB as described in Scenario  2.
Mentions: For Scenario 1 (hemodynamically stable 50-year-old healthy patient with melena), 71% of clinicians transfused at hemoglobin (Hgb) below 70 (mean: 71.0 ± 6.4) and 29% deviated from current guidelines (Figure 1). If the same patient was hemodynamically unstable (Scenario 2), 69.3% of clinicians would provide a transfusion at Hgb below 90 (mean: 86.7 ± 11.8). The distribution of transfusion thresholds for the hemodynamically unstable patient varied by up to 60 g/L (range: 60 g/L to 120 g/L; see Figure 2). Transfusion thresholds for the two scenarios differed significantly (71.0 versus 86.7 g/L, p < 0.001).

Bottom Line: Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L; p < 0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; p < 0.01) were transfused more liberally than healthy patients.Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.

ABSTRACT
Introduction. There is limited data evaluating physician transfusion practices in patients with acute upper gastrointestinal bleeding (UGIB). Methods. A web-based survey was sent to 500 gastroenterologists and hepatologists across Canada. The survey included clinical vignettes where physicians were asked to choose transfusion thresholds. Results. The response rate was 41% (N = 203). The reported hemoglobin (Hgb) transfusion trigger differed by up to 50 g/L. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean Hgb of 86.7 g/L versus 71.0 g/L; p < 0.001). Many clinicians (24%) reported transfusing a hemodynamically unstable patient at a Hgb threshold of 100 g/L and the majority (57%) are transfusing two units of RBCs as initial management. Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L; p < 0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; p < 0.01) were transfused more liberally than healthy patients. Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge. Conclusions. The transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB.

No MeSH data available.


Related in: MedlinePlus