1 research outputs found
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
Gastrointestinal (GI) bleeding is associated with considerable morbidity and
mortality. Red blood cell (RBC) transfusion has long been the cornerstone
of treatment for anemia due to GI bleeding. However, blood is not devoid
of potential adverse effects, and it is also a precious resource, with limited
supplies in blood banks. Nowadays, all patients should benefit from a
patient blood management (PBM) program that aims to minimize blood loss,
optimize hematopoiesis (mainly by using iron replacement therapy), maximize
tolerance of anemia, and avoid unnecessary transfusions. Integration of PBM
into healthcare management reduces patient mortality and morbidity and
supports a restrictive RBC transfusion approach by reducing transfusion rates.
The European Commission has outlined strategies to support hospitals with
the implementation of PBM, but it is vital that these initiatives are translated
into clinical practice. To help optimize management of anemia and iron
deficiency in adults with acute or chronic GI bleeding, we developed a
protocol under the auspices of the Spanish Association of Gastroenterology,
in collaboration with healthcare professionals from 16 hospitals across
Spain, including expert advice from different specialties involved in PBM
strategies, such as internal medicine physicians, intensive care specialists,
and hematologists. Recommendations include how to identify patients who
have anemia (or iron deficiency) requiring oral/intravenous iron replacement
therapy and/or RBC transfusion (using a restrictive approach to transfusion),
and transfusing RBC units 1 unit at a time, with assessment of patients after
each given unit (i.e., “don’t give two without review”). The advantages and
limitations of oral versus intravenous iron and guidance on the safe and
effective use of intravenous iron are also described. Implementation of a PBM
strategy and clinical decision-making support, including early treatment of
anemia with iron supplementation in patients with GI bleeding, may improve
patient outcomes and lower hospital costs