Open questions and misconceptions in the diagnosis and management of anemia in patients with gastrointestinal bleeding

Mearin, Fermı́n; Lanas, Fernando; Bujanda, Luís; Canelles, P; Cotter, José; Hervás, Antonio; Argila, Carlos Martín de; Montoro, Miguel; Gisbert, Javier P.

doi:10.1016/j.gastre.2017.10.001

Cited by 7 publications

(5 citation statements)

References 99 publications

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“…GI bleeding is common in hospital settings and requires management by an interdisciplinary team ( 3 ). Blood volume depletion, loss of RBC mass, and associated clotting disorders require support and replacement strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Acute or chronic gastrointestinal (GI) bleeding affects 47 in 100,000 people worldwide (1) and is one of the most significant clinical problems observed by gastroenterologists, hepatologists, internal medicine physicians, and surgeons (2)(3)(4)(5). Upper GI bleeding is associated with mortality rates of 3-14% (3), while a mortality rate of approximately 3% has been reported in patients with lower GI bleeding (6).…”

Section: Introductionmentioning

confidence: 99%

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Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts

Montoro

Cucala²,

Lanas³

et al. 2022

Front. Med.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts

Montoro

Cucala²,

Lanas³

et al. 2022

Front. Med.

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“…This study concluded that although IV iron is associated with infusion reactions, it is also associated with reduced rates of GI adverse events, and it is not associated with an increased risk of serious adverse events or infections. 15 Furthermore, IV iron is cost-effective compared to other anaemia therapies such as RBC transfusion, [16][17][18] which is a leading indication for acute upper GI bleeding, although the optimal Hb thresholds for transfusion are poorly defined.…”

Section: What the Science Tells Us About How To Treat Gastrointestina...mentioning

confidence: 99%

Practical Management of Anaemia After a Gastrointestinal Bleed

Amisten¹

2019

EMJ Gastroenterol

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Prof Gralnek presented a clinical case on the management of gastrointestinal bleeding (GIB) as a result of Helicobacter pylori infection, and the role of intravenous (IV) ferric carboxymaltose (FCM) as a treatment option for iron deficiency anaemia (IDA) was discussed. IV iron is suitable for patients who have intolerance or limited or no response to oral iron, haemoglobin (Hb) <10 g/dL, or Hb >10 g/dL with cardiovascular or respiratory comorbidities. Prof Gralnek stressed that IDA is common, often underdiagnosed and undertreated, and that the choice between oral or IV iron therapy depends on the degree of anaemia, presence of inflammation, and adherence to oral iron therapy. The main objective of iron treatment is to normalise Hb and iron parameters, and gastroenterologists need to be more aware of anaemia beyond the acute GIB episodes. Prof Lanas presented a clinical case on the management of patients taking anticoagulants (AC) or antithrombotics (AT) who have anaemia due to GIB, and highlighted challenges associated with reducing the risk of bleeds while avoiding thrombotic events. Prof Lanas highlighted clinical dilemmas arising from stopping, restarting, and switching AC in patients with anaemia and GIB, as well as Hb management at discharge. He also stressed that GIB, and especially anaemia or iron storage depletion, are frequently encountered in patients taking AT, and may have a direct impact on mortality, morbidity, and quality of life (QoL). Anaemia and iron deficiency affect mortality, recovery, and QoL in patients who need a rapid restoration of Hb levels and iron stores to decrease the risk of cardiovascular events. Prof Lanas concluded by explaining that FCM therapy has a favourable safety profile, and is more effective, faster, and cost-effective compared to oral iron therapy, and therefore represents a good therapeutic option for anaemic GIB patients with elevated risk of thrombosis.

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“…For hemodynamically unstable patients, transfusion will be necessary and indicated in most cases (7). But for stable patients, the hemoglobin thresholds for which transfusion is indicated are still controversial.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the impact of hemotransfusion on hospitalization length and complications in patients with non-variceal upper gastrointestinal bleeding

Lora,

Tafarel,

Roth

et al. 2023

Braz. J. Hea. Rev.

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Background: Upper gastrointestinal bleeding (UGB) is a common emergency associated with high morbidity and mortality. It can be caused by various factors, including peptic ulcers and vascular lesions. The decision to perform blood transfusion in stable UGB patients is still controversial, with more restrictive strategies showing better outcomes. Methods: A retrospective cohort study reviewed 1433 medical records of non-variceal UGB patients in a Brazilian tertiary care setting. Patients were divided into groups based on whether they received blood transfusion or not. Patient characteristics, laboratory values, procedures, and outcomes were analyzed. Logistic and linear regression models were used to assess the association of blood transfusion with complications and hospital stay. Results: Blood transfusion was associated with increased hospitalization length (p<0.001), higher rebleeding rates (p<0.001), and greater clinical severity. However, no association with worse renal outcomes was observed (p=0.203). Adjusting for clinical severity (Glasgow-Blatchford score) reduced the significance of the association with hospitalization length. Conclusion: Blood transfusion in stable UGB patients may serve as a marker of severity, associated with longer hospital stay and increased rebleeding rates. It does not appear to have a direct causal relationship with worse renal outcomes. The study suggests that clinical severity may play a pivotal role in outcomes, as indicated by the association with Glasgow-Blatchford score.

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Open questions and misconceptions in the diagnosis and management of anemia in patients with gastrointestinal bleeding

Cited by 7 publications

References 99 publications

Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts

Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts

Practical Management of Anaemia After a Gastrointestinal Bleed

Evaluation of the impact of hemotransfusion on hospitalization length and complications in patients with non-variceal upper gastrointestinal bleeding

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