title: Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists.
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% (N = 203). 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; p < 0.001). 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; p < 0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; p < 0.01) 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.
authors.affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Fortinsky
authors.affiliation: Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Myriam
authors.identifier: 0000-0001-8317-613X
authors.initials: M
authors.lastname: Martel
authors.affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.
authors.forename: Roshan
authors.initials: R
authors.lastname: Razik
authors.affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.
authors.forename: Gillian
authors.initials: G
authors.lastname: Spiegle
authors.affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.
authors.forename: Zane R
authors.initials: ZR
authors.lastname: Gallinger
authors.affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.
authors.forename: Samir C
authors.initials: SC
authors.lastname: Grover
authors.affiliation: Division of Hematology and Transfusion Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Katerina
authors.initials: K
authors.lastname: Pavenski
authors.affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.
authors.forename: Adam V
authors.initials: AV
authors.lastname: Weizman
authors.affiliation: Division of Gastroenterology, Western University, London, ON, Canada.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Kwapisz
authors.affiliation: Division of Critical Care, University of Toronto, Toronto, ON, Canada.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gray
authors.affiliation: Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, McGill University, Montreal, QC, Canada; Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Alan N
authors.identifier: 0000-0002-1798-5526
authors.initials: AN
authors.lastname: Barkun
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002170:Canada; D004909:Erythrocyte Indices; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D000072102:Gastroenterologists / Q000706:statistics & numerical data*; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000628:therapy*; D006801:Humans; D007501:Iron / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012016:Reference Values; D011795:Surveys and Questionnaires
chemical_list: D007501:Iron