There was an interesting commentary on best ways of managing patients presenting with acute gastrointestinal bleeding on medscape today. It mainly focused on guiding when a patient should be transfused with blood and when to decide on a more conservative approach.
Usually blood transfusions are indicated if the patient has lost a large amount of blood and when effective circulation requires more red blood cells in the circulation.
The commentary favours the use of more conservative approach in using blood transfusions in patients with Upper GI bleeding. According to a study conducted in UK, There was no adverse out comes when using the more conservative approach. The study had two arms. One arm with the conservative strategy where blood transfusions were given after Haemoglobin (Hb) has dropped below 7g/dl and the other arm with a more liberal approach where blood transfusions where given when Hb dropped below 9g/dl.
It is known that adverse effects such as fluid overload and reactions can complicate the disease conditions of patients undergoing blood transfusions.
But the commentary does not give a clear idea whether this study has taken into account the normal Hb levels of the patient since a Hb level of even 9g/dl could be a significantly low value if the patient had a Hb level of >12 prior to the incident.
Check out the article using following URL for more details.
Common reasons for upper GI bleeding include lower esophageal varices secondary to portal hypertension and Gastric / Duodenal Ulcers. Most common reason for portal hypertension in adults is liver cirrhosis. In children portal hypertension is commonly seen secondary to portal vein thrombosis (pre - hepatic).