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

Abstract EN

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.