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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

By Kyle J. Fortinsky, Myriam Martel, Roshan Razik, Gillian Spiegle, Zane R. Gallinger, Samir C. Grover, Katerina Pavenski, Adam V. Weizman, Lukasz Kwapisz, Sangeeta Mehta, Sarah Gray and Alan N. Barkun

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

Topics: Diseases of the digestive system. Gastroenterology, RC799-869
Publisher: Hindawi Publishing Corporation
Year: 2016
DOI identifier: 10.1155/2016
OAI identifier: oai:doaj.org/article:8c2c9ba8b4ce4f6399eaed0fb4e199dd
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