CanadiEM MVP Infographic Series – Transfusion Strategies for Acute Upper GI Bleeding

In Infographics by Alixe DickLeave a Comment

Approximately 20 million units of red blood cells, platelets and plasma are transfused annually in the United States1! Each transfusion carries an element of risk to the patient. Although numerous testing standards have been established to prevent the transmission of infectious diseases (i.e. HIV or Hepatitis C), immune reactions and alterations in homeostasis can still cause patients significant harm. The world of transfusion medicine has changed drastically over the last few decades with more conservative guidelines being established as best practice. In early 2000s Grlanek et al. and Barkun et al. determined that restrictive transfusion strategies are as effective as liberal transfusion strategies, while reducing the use of blood supplies.2,3

Acute upper gastrointestinal bleeding (UGIB) is a common emergency condition that is associated with a high morbidity and mortality rate.4 Previous to 2013, the guidelines to transfuse this population group were controversial. Villanueva et al. were the first to examine the hemoglobin threshold for transfusion of red cells within this population group.4 They compared the efficacy and safety of a restrictive vs. liberal hemoglobin threshold for red cell transfusion. They determined that a restrictive transfusion strategy with a threshold for transfusion of 70 g/L can decrease mortality at 45 days, rates of further bleeding and rates of transfusion.

The methods and results are highlighted above. Limitations of this study included: patients with a low risk of re-bleeding or with massive hemorrhage were excluded and this study was not blinded which may have introduced bias. Villanueva et al.’s important study in 2013 provided knowledge around restrictive transfusion guidelines, which changed several emergency physicians’ practice!

References

1.
Advances in Transfusion Medicine . American Society of Hematology. http://www.hematology.org/About/History/50-Years/1531.aspx. Accessed January 4, 2019.
2.
Gralnek IM, Barkun AN, Bardou M. Management of Acute Bleeding from a Peptic Ulcer. N Engl J Med. 2008;359(9):928-937. doi:10.1056/nejmra0706113
3.
Barkun A, Bardou M, Marshall JK. Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding. Ann Intern Med. 2003;139(10):843. doi:10.7326/0003-4819-139-10-200311180-00012
4.
Villanueva C, Colomo A, Bosch A, et al. Transfusion Strategies for Acute Upper Gastrointestinal Bleeding. N Engl J Med. 2013;368(1):11-21. doi:10.1056/nejmoa1211801
Alixe Dick

Alixe Dick

Alixe Dick is a third year medical student at the University of Saskatchewan. Alixe is also a registered nurse who previously worked in emergency services in Saskatoon, SK. She is interested in medical education, simulation and addictions medicine.

Alvin Chin

Alvin is currently a PGY5 in the FRCP EM program at McMaster University. He serves as Director of Design for CanadiEM and has interests in knowledge translation and health innovation.