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Canadian Journal of Gastroenterology and Hepatology
Volume 2016, Article ID 5610838, 8 pages
http://dx.doi.org/10.1155/2016/5610838
Research Article

Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists

1Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
2Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, McGill University, Montreal, QC, Canada
3Division of Hematology and Transfusion Medicine, University of Toronto, Toronto, ON, Canada
4Division of Gastroenterology, Western University, London, ON, Canada
5Division of Critical Care, University of Toronto, Toronto, ON, Canada
6Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
7Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, QC, Canada

Received 23 December 2015; Accepted 17 May 2016

Academic Editor: Geoffrey Williams

Copyright © 2016 Kyle J. Fortinsky et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. There is limited data evaluating physician transfusion practices in patients with acute upper gastrointestinal bleeding (UGIB). Methods. A web-based survey was sent to 500 gastroenterologists and hepatologists across Canada. The survey included clinical vignettes where physicians were asked to choose transfusion thresholds. Results. The response rate was 41% (). The reported hemoglobin (Hgb) transfusion trigger differed by up to 50 g/L. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean Hgb of 86.7 g/L versus 71.0 g/L; ). Many clinicians (24%) reported transfusing a hemodynamically unstable patient at a Hgb threshold of 100 g/L and the majority (57%) are transfusing two units of RBCs as initial management. Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L; ) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; ) were transfused more liberally than healthy patients. Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge. Conclusions. The transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB.