title: Transfusion-free management of gastrointestinal bleeding: the experience of a bloodless institute.
abstract: OBJECTIVE
  The Institute for Patient Blood Management and Bloodless Medicine at the Englewood Hospital has considerable experience in managing patients with gastrointestinal bleeding who do not accept blood-derived products. We present our data and experience over the last 8 years in managing such patients.
  
  
  BACKGROUND
  There is paucity of data on management and outcomes of gastrointestinal bleeding in patients who do not accept blood-derived products.
  
  
  METHODS
  We performed a retrospective study of patients from 2003 to 2011 presenting with gastrointestinal bleeding who do not accept blood-derived products. Inclusion criteria were either overt bleeding with a presenting hemoglobin (Hb) of <12 g/dL or a decrease in Hb of >1.5 g/dL.
  
  
  RESULTS
  Ninety-six patients who met the inclusion criteria were included. Forty-one upper and 48 lower gastrointestinal bleeding sources were identified. Mean Hb was 8.8 g/dL and mean nadir was 6.9 g/dL. Among 37 patients (80.5%) with Hb ≤6.0 g/dL, 30 (81%) survived. Four of 7 patients (57%) with a Hb <3 g/dL survived. The overall mortality rate was 10.4%. In unadjusted logistic regression models, age [1.06 (1.01-1.12 y)], admission to ICU [6.37(1.27-31.9)], and anticoagulation use [6.95 (1.57-30.6)] were associated with increased mortality. Initial Hb [0.68 (0.51-0.92)] and nadir Hb [0.48 (0.29-0.78)] inversely predicted mortality.
  
  
  CONCLUSIONS
  These results suggest that transfusion-free management of gastrointestinal hemorrhage can be effective with mortality comparable with the general population accepting medically indicated transfusion. Management of these patients is challenging and requires a dedicated multidisciplinary team approach knowledgeable in techniques of blood conservation.
authors.affiliation: *Department of Medicine ‡Department of Gastroenterology, Englewood Hospital and Medical Center, Englewood, NJ †University of Miami Leonard Miller School of Medicine, Miami, FL.
authors.forename: Prabin
authors.initials: P
authors.lastname: Sharma
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Barajas
authors.forename: Parasuram
authors.initials: P
authors.lastname: Krishnamoorthy
authors.forename: Lyna M
authors.initials: LM
authors.lastname: Campo
authors.forename: Ezra
authors.initials: E
authors.lastname: Blumenthal
authors.forename: Mitchell
authors.initials: M
authors.lastname: Spinnell
mesh_terms: D000047:Academies and Institutes; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D057668:Bloodless Medical and Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins