Impact of blood transfusion on outcome in patients admitted for gastrointestinal hemorrhage

PURPOSE:Patients admitted with the diagnosis of gastrointestinal bleeding at our institution typically undergo diagnostic/therapeutic endoscopy. Surgery is consulted and operative intervention considered when the patient has reached a 6-unit transfusion requirement for resuscitation. The purpose of this study is to examine the association between number of units transfused and clinical outcome in patients admitted for gastrointestinal hemorrhage.A retrospective review of records of patients admitted to the 81st Medical Group between January 1996 and January 2000 was conducted. Patients admitted with a diagnosis of upper or lower gastrointestinal hemorrhage were identified. Of this group, the records of those patients receiving at least 1 unit of packed red blood cells were examined.Thirty-five complete records were available for review. Patients ranged from 3 to 79 years of age. The male to female ratio was 4:1. The group received an average of 5.2 units of packed red blood cells. Eight patients were identified as having received more than 6 units of packed red cells. Three of 4 patients who underwent operative intervention had transfusion requirements in excess of 6 units. All 4 operative patients were classified as ASA class IIIE. Seven deaths (20%) occurred among the 35 patients, 3 of whom had received more than 6 units of blood.Patients admitted with gastrointestinal hemorrhage who require less than 6 units of blood may have a lower chance of dying (15%) than do patients requiring more than 6 units of blood (38%). Emergent surgical intervention, even in high-risk patients, can be safely performed.