[Blood transfusions in hemorrhage of the upper digestive tract]

On the basis of data published, at least three quarters of patients with acute haemorrhage of the upper digestive tract (AHUDT) undergo blood transfusions. An epidemiologic survey carried out over a period of more than two years, showed that only 322 subjects out of 587 (54.8%) with AHUDT received blood transfusions, the mean need being 3.6 +/- 6.1 units of packed erythrocytes. Our series included a relevant percentage (29%) of hepatocirrhotics, whose transfusion need was, as expected, markedly higher in comparison with the others (71% transfused versus 47.9%, and a mean of 5.3 units versus 2.9). Persistent bleeding, rebleeding rate, operation and mortality rate in our study were, respectively, 4.1%, 28.4%, 10.2% and 15.5%. Mortality among subjects non transfused was 3.4%. The adoption of restrictive criteria made it possible to avoid unnecessary blood transfusions. Patients who were hemodynamically stable with haemoglobin greater than 8 g/dl were not transfused. Our experience has shown that about fifty per cent of patients with AHUDT can be preserved from the risks connected with blood transfusions.