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Gastrointestinal hemorrhage: should we transfuse less?
1Division of Clinical Practice and Population Health, Faculty of Health Sciences, Newcastle University, Newcastle, 2308, Australia. duggan@hunterlink.net.au
Digestive Diseases and Sciences
|November 27, 2008
Summary
Blood transfusions for acute upper gastrointestinal bleeding may cause harm. Stored blood can impair clotting and increase infection risk, suggesting conservative transfusion strategies may be beneficial.
Area of Science:
- Gastroenterology
- Hematology
- Transfusion Medicine
Background:
- Blood transfusion is standard for acute upper gastrointestinal hemorrhage.
- Transfusion is associated with significant adverse effects, both immediate and delayed.
Purpose of the Study:
- To evaluate the significance and importance of adverse transfusion side effects.
- To assess the impact of blood transfusion on hemostasis and infection rates in patients with acute upper GI bleeding.
Main Methods:
- A literature search was conducted using Ovid Medline.
- Studies evaluating transfusion effects on hemostasis, infection, and mortality were reviewed.
Main Results:
- Evidence suggests impaired hemostasis with acute blood volume repletion.
- Stored blood has immunosuppressive effects, increasing infection rates and mortality.
- Effects are dependent on transfusion dose and storage duration of blood.
Conclusions:
- Early blood volume restoration may increase bleeding.
- Stored blood's immunosuppressive effects warrant consideration.
- Conservative blood utilization trials are needed for acute GI bleeding management.
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