Over Transfused

A new paper from NEJM indicates that perhaps we need to re-calibrate our blood transfusion strategies in patients with severe upper gastrointestinal bleeds.  Patients were randomly assigned to liberal (transfuse for HgB under 9) vs restrictive (transfuse only for HgB under 7) transfusion treatment protocols and outcomes were measured (survival, bleeding, portal venous gradients, etc).  The probability of survival was slightly higher with the restrictive strategy than with the liberal strategy in the subgroup of patients who had bleeding associated with a peptic ulcer (hazard ratio, 0.70; 95% CI, 0.26 to 1.25) and was significantly higher in the subgroup of patients with cirrhosis and Child–Pugh class A or B disease (hazard ratio, 0.30; 95% CI, 0.11 to 0.85), but not in those with cirrhosis and Child–Pugh class C disease (hazard ratio, 1.04; 95% CI, 0.45 to 2.37). Historically, patients who come in with massive GI bleeds due to ulcer disease are aggressively resuscitated with blood products and saline until they achieve hemodynamic stability (and if not, it's off to the OR).  The decision to transfuse blood typically was a clinical decision, not one driven primarily by arbitrary hemoglobin counts. The real life applicability of these findings is somewhat dubious.  In an emergency situation, when a patient is hemodynamically labile in the ER and you aren't certain of the past medical history and blood is spewing o...
Source: Buckeye Surgeon - Category: Surgeons Authors: Source Type: blogs