title: Red blood cell transfusion practice in patients presenting with acute upper gastrointestinal bleeding: a survey of 815 UK clinicians.
abstract: BACKGROUND
  Acute upper gastrointestinal bleeding (AUGIB) accounts for 14% of all red blood cell (RBC) transfusions in the United Kingdom, despite little evidence to guide optimal blood transfusion strategies and few data on the variation in practice. We aimed to survey UK clinicians about their RBC transfusion practice in AUGIB.
  
  
  METHODS
  A survey describing six clinical vignettes of AUGIB was sent to practicing gastroenterologists, acute care physicians, and upper gastrointestinal surgeons. Respondents were asked to select a hemoglobin (Hb) trigger at which they would ordinarily transfuse RBCs.
  
  
  RESULTS
  The response rate was 48% (815/1709). Transfusion triggers differed significantly between all six cases (p < 0.001). There was significant variation in the selected Hb trigger between different clinical specialties for five of the six scenarios. Surgeons were more likely to select a lower Hb transfusion trigger than physicians across all six scenarios (p < 0.005), as were clinicians who had graduated more recently (p < 0.05 for Scenarios 1-3). The responses suggested the belief that restrictive use of RBCs is appropriate, which is in part discordant with actual observed practice. Only 70% of respondents reported familiarity with national guidelines for AUGIB.
  
  
  CONCLUSIONS
  There is significant variation in the reported approach to transfusion practice among clinicians caring for patients with AUGIB, with both patient- and clinician-related factors accounting for these differences. Further studies are needed to evaluate the safety and efficacy of differing blood transfusion strategies in patients presenting with AUGIB.
authors.affiliation: NHS Blood & Transplant and Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK. vipul.jairath@nhsbt.nhs.uk
authors.forename: Vipul
authors.initials: V
authors.lastname: Jairath
authors.forename: Brennan C
authors.initials: BC
authors.lastname: Kahan
authors.forename: Richard F A
authors.initials: RF
authors.lastname: Logan
authors.forename: Simon P L
authors.initials: SP
authors.lastname: Travis
authors.forename: Kelvin R
authors.initials: KR
authors.lastname: Palmer
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011795:Surveys and Questionnaires; D006113:United Kingdom