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!