The results of our study support the need for the continued use of prophylaxis with platelet transfusion and show the benefit of such prophylaxis for reducing bleeding, as compared with no prophylaxis. A significant number of patients had bleeding despite prophylaxis. (Funded by the National Health Service Blood and Transplant Research and Development Committee and the Australian Red Cross Blood Service; TOPPS Controlled-Trials.com number, ISRCTN08758735.).

NHS Blood and Transplant Research and Development.

Summary:relapse rates than those achieved with autologous transplants. 4,5 The concept of a graft-versus-lymphoma effect, however, remains unproven, because of the inclusion of Donor lymphocyte infusions, by virtue of a graft-versustumor effect, have been shown to induce remissions in heterogeneous patient populations in lymphoma studies and a high treatment-related mortality rate. leukemia that recurs after allogeneic bone marrow transplantation. Similar effects have been postulated to Discontinuation of immunosuppressive therapy or donor lymphocyte infusions have been successfully used to induce contribute to the decreased recurrence rate observed after allogeneic transplantation in non-Hodgkin's lymremissions in patients in whom disease has recurred after allogeneic transplantation for chronic or acute myelogenous phoma. This lower recurrence rate may be due to a variety of other mechanisms. We aimed to evaluate the role leukemia. 6 Similar observations have been reported for patients with multiple myeloma. 7 We have used immunoof graft-versus-lymphoma effects in patients in whom lymphomas recur after allogeneic transplantation. At logic manipulations in several patients with non-Hodgkin's lymphoma in whom disease recurred after allogeneic the time of recurrence, immunosuppressive therapy was withheld. Patients with non-responding disease received transplantation; complete or partial responses have been observed in four of nine patients. an infusion of donor lymphocytes. Patients were observed for response and graft-versus-host disease.

Increasingly, emergency and ENT departments are being presented with epistaxis in patients taking anticoagulant or antiplatelet medication. A better understanding of such medication and its effects may enable more effective management of these patients.

ObjectivesData on costs associated with acute upper gastrointestinal bleeding (AUGIB) are scarce. We provide estimates of UK healthcare costs, indirect costs and health-related quality of life (HRQoL) for patients presenting to hospital with AUGIB.SettingSix UK university hospitals with >20 AUGIB admissions per month, >400 adult beds, 24 h endoscopy, and on-site access to intensive care and surgery.Participants936 patients aged ≥18 years, admitted with AUGIB, and enrolled between August 2012 and March 2013 in the TRIGGER trial of AUGIB comparing restrictive versus liberal red blood cell (RBC) transfusion thresholds.Primary and secondary outcome measuresHealthcare resource use during hospitalisation and postdischarge up to 28  days, unpaid informal care, time away from paid employment and HRQoL using the EuroQol EQ-5D at 28  days were measured prospectively. National unit costs were used to value resource use. Initial in-hospital treatment costs were upscaled to a UK level.ResultsMean initial in-hospital costs were £2458 (SE=£216) per patient. Inpatient bed days, endoscopy and RBC transfusions were key cost drivers. Postdischarge healthcare costs were £391 (£44) per patient. One-third of patients received unpaid informal care and the quarter in paid employment required time away from work. Mean HRQoL for survivors was 0.74. Annual initial inhospital treatment cost for all AUGIB cases in the UK was estimated to be £155.5 million, with exploratory analyses of the incremental costs of treating hospitalised patients developing AUGIB generating figures of between £143 million and £168 million.ConclusionsAUGIB is a large burden for UK hospitals with inpatient stay, endoscopy and RBC transfusions as the main cost drivers. It is anticipated that this work will enable quantification of the impact of cost reduction strategies in AUGIB and will inform economic analyses of novel or existing interventions for AUGIB.Trial registration numberISRCTN85757829 and NCT02105532.