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Transfusion in Gastrointestinal Bleeding

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Transfusion in the Intensive Care Unit

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Abstract

Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency which can present with life-threatening bleeding which is the single leading indication for transfusion of red blood cells in the UK. AUGIB is a condition associated with increasing age and comorbidity and with liver cirrhosis. Variceal bleeding in patients with liver cirrhosis presents a particular challenge due to multifactorial underlying derangements in coagulation, as well as the risks of exacerbation of portal hypertensive bleeding through injudicious volume replacement. A single high-quality trial has demonstrated that a restrictive approach to red blood cell transfusion (transfusion threshold of 7 g/dL) leads to a reduction in mortality and rebleeding, compared to a liberal transfusion strategy (transfusion threshold of 9 g/dL). However, this treatment effect was only significant for patients with liver cirrhosis, and the results cannot be generalised to patients with cardiovascular comorbidities. Although consensus guidelines recommend platelet transfusions to actively bleeding patients with a count of <50 × 109, there is no evidence base to these recommendations, and this cannot be routinely advocated for AUGIB until there is further evidence. Similarly there is little evidence to guide plasma transfusion, and the harms associated with this intervention must be considered prior to transfusion. The presence of coagulopathy is associated with an increased risk of mortality, but it is unclear if this is simply a biomarker of illness rather than an indication for correction. Trials of antifibrinolytics have been shown to reduce mortality after AUGIB, but many of these studies were conducted before the advent of modern day endoscopy, raising uncertainty as to their effectiveness. Massive transfusion protocols should be used with caution in AUGIB due to the risk of volume overload in elderly patients. AUGIB is an important cause of morbidity and mortality worldwide and a major user group of all blood components, and therefore further research is justified to improve the evidence base for the approach to transfusion.

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Authors and Affiliations

  1. Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK

    Vipul Jairath BSc, MBChB(hons), DPhil, MRCP

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  1. Vipul Jairath BSc, MBChB(hons), DPhil, MRCP
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Correspondence to Vipul Jairath BSc, MBChB(hons), DPhil, MRCP .

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  1. Department of Intensive Care L.E.I.C.A., Academic Medical Center, Amsterdam, The Netherlands

    Nicole P. Juffermans

  2. MRC Centre for Inflammation Research, University of Edinburgh The Queens Medical Research Institute, Edinburgh, United Kingdom

    Timothy S. Walsh

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Jairath, V. (2015). Transfusion in Gastrointestinal Bleeding. In: Juffermans, N., Walsh, T. (eds) Transfusion in the Intensive Care Unit. Springer, Cham. https://doi.org/10.1007/978-3-319-08735-1_12

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  • DOI: https://doi.org/10.1007/978-3-319-08735-1_12

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