The impact of HIV testing on blood utilization in the intensive care unit in patients with gastrointestinal bleeding

To determine whether the AIDS epidemic has influenced physician use of blood products in intensive care unit management of gastrointestinal hemorrhage.

Retrospective chart review of 148 patients with gastrointestinal hemorrhage admitted to the intensive care unit. Forty-eight patients were admitted before the onset of HIV testing of the blood supply (group 1) and 100 were admitted after HIV testing was begun (group 2).

Of the 148 patients, 18 (eight in group 1, ten in group 2) were not transfused and had higher median hemoglobin levels on admission and higher median hemoglobin nadirs during hospitalization than patients who were transfused. Transfused patients in group 2 did not have significantly lower median hemoglobin levels on admission [7.9(4.2-12.5) g/dl] than transfused patients in group 1 [9.3 (4.1-13.5) g/dl] (p = 0.058). Patients in group 2 had significantly lower median hemoglobin concentrations prior to the first transfusion event [7.4 (4.2-10.3) g/dl] than those in group 1 [8.5 (4.2-12.1) g/dl] (p = 0.016). There were no significant differences between the two groups in terms of the total number of units of packed red blood cells, fresh frozen plasma or platelets transfused. Neither was any significant difference in mortality observed, with 11 patients (22.9%) dying in group 1 and 23 patients (23.0%) dying in group 2. The cause of death in 13 of the 34 patients was related to cardiovascular and hemodynamic complications of gastrointestinal bleeding. There was no significant difference in mean age (group 1: 60.5 years, group 2: 59.4 years) or mean hemoglobin nadir (group 1: 7.0 g/dl, group 2: 7.1 g/dl) among those who died in the two groups.

These data indicate that physicians are transfusing patients at lower hemoglobin levels than they did before the beginning of HIV testing. However, there has been no decrease in the total median amount of blood products transfused since that time. This change in practice may be due to increased concern about HIV transmission through blood products and suggests the need for greater awareness of existing transfusion guidelines.