Recurrent bleeding in acute upper gastrointestinal hemorrhage: transfusion confusion

Abstract

Objective: Acute upper gastrointestinal (UGI) hemorrhage is a common, often serious condition encountered in the emergency department (ED). Previous research has suggested that transfusion of blood products may interfere with the hypercoagulable state induced by significant blood loss. Our objective was to determine whether the frequency of rebleeding is higher in patients with UGI bleeding who have received early blood transfusion. Methods: The study was a retrospective chart review of patients admitted to hospital through the ED with a diagnosis of UGI hemorrhage. Inclusion criteria limited analysis to patients presenting with hematemesis, melena, or bloody nasogastric aspirate, in whom a UGI lesion was confirmed endoscopically during admission. Results: A total of 214 charts were analyzed. Baseline demographic characteristics were similar in transfused and non-transfused patients. Presenting hemoglobin level was lower in the transfused group (86.5 v. 119.2 g/L, p < 0.001). Recurrent bleeding occurred in 99 (46%) patients and was more common in transfused patients (67 [66%] v. 33 [29%], p < 0.001). Logistic regression analysis revealed that transfusion and presenting hemoglobin level were the only variables with a statistically significant independent association with bleeding recurrence (p < 0.001 and p < 0.05 respectively). Conclusions: Our results support previous research suggesting that transfused UGI bleed patients have a higher rate of rebleeding. However, because of the retrospective design, causality cannot be inferred. RÉSUMÉObjectifs : L'hémorragie digestive aiguë haute est une atteinte courante, souvent grave rencontrée à l'urgence. Des recherches antérieures ont soulevé la possibilité que la transfusion de produits sanguins peut affecter l'état d'hypercoagulabilité provoqué par une déperdition sanguine importante. Notre objectif était de déterminer si la fréquence de récidives hémorragiques était plus élevée chez les victimes d'hémorragie digestive haute ayant reçu une transfusion sanguine tôt dans leur traitement.

Clinical and endoscopic profile of patients with upper gastrointestinal bleeding at tertiary care center of North India

“…In a study done by Jeffery it is found that the outcome of transfused patients was significantly worse than that of nontransfused patients. [4] In a study done by Schiller et al patients given a transfusion of not more than 4 bottles had a low fatality rate which was similar to that of those who were not transfused. Patients receiving 5-10 bottles of blood had double this fatality rate.…”

“…Patients can be stratified as having either variceal or nonvariceal sources of upper GI hemorrhage as the two have different treatment algorithms and prognosis. [4] The primary diagnostic test for evaluation of UGIB is endoscopy. Early endoscopy and endoscopic appearance of certain lesions helps to guide care and thereby reduce the costs and duration…”

Retrospective Study of Clinical Profile, Endoscopic Profile and in Hospital Mortality in Acute Upper Gastrointestinal Bleeding in Tertiary Care Centre in South India

“…4,5 Patients can be divided as having either variceal or nonvariceal sources of upper GI hemorrhage as the two have different management protocols and prognosis. 6 The primary diagnostic test for evaluation of upper GI bleeding is endoscopy. Endoscopy for upper GI bleed has a sensitivity of 92%-98% and specificity of 30%-100%.…”

Clinical, Endoscopic Profile and Management of Patients with Upper Gastrointestinal Bleeding in Tertiary Care Center in Southern Karnataka

“…3,4 With the increasing incidence of use of NSAIDS in the elderly, the pateints presenting the above cause in about two third the population also due to high prevelance to comorbid conditions (like cardiovascular disease) 5,7 Patients with upper GI bleed can be divided into variceal and non variceal sources of bleed each have different protocols of management and prognosis. 6 The first and the most common cause is portal hypertension resulting in gastroesophageal varices and portal hypertensive gastropathy, second most common cause being peptic ulcer disease, other causes include erosive gastritis, reflux esophagitis, Mallory weiss tear, malignancy etc. Patients with age more than 60 years had mortality rates ranging from 12-35%, patients with age less than 60 years was <10% and overall mortality rates of 5-11%, as noted in previous studies.…”