On 2/19, we’ll discuss the recent NEJM publication on transfusion strategies in upper GI bleeds. Their results may surprise you. Can they be extrapolated to other bleeders?
Read, enjoy, and post.
http://www.nejm.org/doi/full/10.1056/nejmoa1211801
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Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
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3 Comments
TSmith · February 18, 2014 at 9:35 pm
I remember being a resident in the MICU, transfusing patients (esp if they had a cardiac history) to a target hgb of 10, no matter if they GIB or not. But, I haven’t practice that as Attending. I don’t get nervous about a drop until lower than 7, even if GIB. I think we should go more by trend in H/H and symptoms than playing the numbers game.
andygrock · February 18, 2014 at 9:48 pm
Sorry for the late reply. In general, I think this is yet another example of doctors doing too much and causing harm. Reminds me of a rule from House of God – “the ideal delivery of medical care is to do as much nothing as possible.” I like Dr. Smith’s recommendation for trends, and will add in including patient’s symptoms in deciding whether or not to transfuse.
Also, there was a great sub-group analysis of this paper found here
http://www.ncbi.nlm.nih.gov/pubmed/11246298 titled “transfusion threshold safe in critically ill patients with cardiovascular diseases?” The gist is: they divided patients with known cardiac dx into hgb goal of 10 vs hgb goal of 7. Results: less blood given to restrictive strategy, equal mortality and length of ICU stay, less incidences of end organ damage.
jmchugh · February 18, 2014 at 11:06 pm
Recently on my medicine rotation, we would transfuse patients whose Hb fell below 7, to a goal of 8. Otherwise, we would use serial Hbs. I also remember that GI would not scope anyone below an Hb of 8 (for one pt, they would not scope unless the Hb was 10). I think this study can be used in the argument against transfusion to a goal of 10. But obviously, if a pt needs to be scoped, given the risk and complications of scoping, a Hb of 8 would seem acceptable. The question I do have, is how do we apply this information to pt with chronically low Hb, such as sicklers or pt with anemia of chronic disease?