Blood transfusion practices in upper gastrointestinal bleeding: response to a landmark study

Area of Science:

• Hematology
• Gastroenterology
• Clinical Practice Guidelines

Background:

• Red blood cell (RBC) transfusion guidelines for gastrointestinal bleeding have varied due to a lack of clear evidence.
• A significant study in 2013 provided evidence for appropriate RBC transfusion thresholds in upper gastrointestinal (UGI) bleeding.
• This study aimed to assess institutional changes in RBC transfusion practices following the publication of this landmark evidence.

Purpose of the Study:

• To evaluate the impact of a landmark 2013 study on RBC transfusion practices in patients with UGI bleeding.
• To determine if evidence-based transfusion thresholds led to improved RBC transfusion appropriateness.
• To quantify the rate of appropriate RBC transfusions before and after the dissemination of new evidence.

Main Methods:

• Retrospective analysis of RBC transfusion practices in UGI bleeding patients at a single institution.
• Data collected from January 2010 to December 2013, encompassing demographic, clinical, and laboratory information.
• Appropriate RBC transfusion defined as transfusion for hemoglobin levels below 70 g/L.

Main Results:

• A total of 606 RBC transfusions were analyzed in 270 patients with UGI bleeding.
• The rate of appropriate RBC transfusions increased significantly from 54% in 2010-2012 to 70% in 2013 (p=0.003).
• Despite improvement, 251 (41.4%) of the transfusions were deemed inappropriate during the study period.

Conclusions:

• The findings suggest an improvement in RBC transfusion practices following the landmark 2013 study on UGI bleeding.
• RBC transfusion practices for UGI bleeding, while improved, still require optimization.
• Further efforts are needed to ensure adherence to evidence-based transfusion guidelines in clinical practice.